Immune thrombocytopenic purpura in ulcerative colitis: a case report and systematic review

Abstract

Over 100 extraintestinal manifestations are reported in ulcerative colitis (UC). A commonly reported hematological manifestation is autoimmune hemolytic anemia. On rare occasions, immune thrombocytopenic purpura (ITP) has been reported with UC. The presence of thrombocytopenia can complicate the clinical scenario as the number of bloody bowel movements is an important indicator of disease activity in UC. A proposed theory for this association is antigenic mimicry between a platelet surface antigen and bacterial glycoprotein. We are reporting a case of UC and associated ITP managed successfully with anti-TNF therapy. We also performed a systemic review of case reports and a case series reporting this association.

Concomitant Immune Thrombocytopenic Purpura and Crohn’s Disease

“…The association between ITP and UC has been well described [5]. Although the prevalence of concomitant ITP in UC patients is reportedly 0.1-0.48% [22,23], the incidence of ITP in CD patients remains unknown.…”

“…In majority of the cases, ITP resolved following the treatment of UC flares [5]. Therefore, the authors proposed antigenic mimicry associated with luminal antigen and platelet surface antigen as the major pathogenic mechanism underlying concomitant ITP and CD [5]. The most commonly accepted pathogenic mechanism proposes that the presence of circulating immune complexes in the serum of CD patients is associated with the onset of CD extraintestinal manifestations [25] and antigenic mimicry due to increased mucosal permeability in active colitis through enhanced exposure of the intestinal immune system to luminal antigens [24].…”

“…In majority of the cases, ITP resolved following the treatment of UC flares [5]. Therefore, the authors proposed antigenic mimicry associated with luminal antigen and platelet surface antigen as the major pathogenic mechanism underlying concomitant ITP and CD [5].…”

“…A systematic review (40 cases of concomitant ITP and UC) by Chandra et al [5] suggested that ITP occurs during or after the onset of colitis in many cases of concomitant ITP and UC. In majority of the cases, ITP resolved following the treatment of UC flares [5].…”

“…Common autoimmune hematological disorders include autoimmune hemolytic anemia (AIHA), immune (or idiopathic) thrombocytopenic purpura (ITP), and pernicious anemia [4,5]. ITP is characterized by the presence of autoantibodies against platelet surface antigens leading to immune-mediated platelet destruction and low platelet counts [4].…”