Primary, secondary or less frequent causes of immune thrombocytopenia: A case report

Abstract

Primary immune thrombocytopenia (ITP) is characterized by isolated low platelet count and it is a diagnosis of exclusion, contrasting to secondary ITP. Therefore, a positive diagnosis is difficult and requires extensive investigation. Some of the underlying conditions that are associated with ITP are lymphoproliferative disorders and infections, especially viral ones. In the present study, the case of a patient diagnosed with diffuse large B-cell lymphoma, who received chemotherapy and autologous hematopoietic stem cell transplantation is presented. After a complete remission of four years, the patient presented with sudden intense hemorrhagic syndrome and severely decreased platelet count. The most frequent causes of secondary ITP were excluded, including lymphoma relapse, and intravenous corticosteroids were started. However, shortly after hospital admission, the patient developed neuro-psychiatric anomalies, fever and pancytopenia, and West-Nile encephalitis was diagnosed. Although the initial development was favorable, he started to complain of progressive severe muscle weakness and eventually succumbed to infectious complications in the setting of prolonged hospitalization, corticotherapy, and immobilization.

Early treatment of rituximab combined with eltrombopag for secondary thrombocytopenic purpura in rheumatoid arthritis

“…Secondary refers to thrombocytopenia caused by other diseases or drugs. Recent reports confirm that autoimmune diseases, patients with low cellular immune function, viral infections, and the use of drugs such as quinine and heparin are important causations of ITP [6–8] . Although RA and secondary ITP are common clinical diseases, we found that effective treatment of ITP is rarely reported in patients with RA in China.…”

“…Recent reports confirm that autoimmune diseases, patients with low cellular immune function, viral infections, and the use of drugs such as quinine and heparin are important causations of ITP. [ 6 – 8 ] Although RA and secondary ITP are common clinical diseases, we found that effective treatment of ITP is rarely reported in patients with RA in China. Therefore, we reviewed the changes of drug therapy and laboratory tests in this patient, providing an important reference for the treatment of ITP with RA.…”

Current Understanding of Immune Thrombocytopenia: A Review of Pathogenesis and Treatment Options

“…Primary ITP arises from several different mechanisms [15], such as the peripheral destruction of platelets opsonized by antiplatelet antibodies [16], impaired thrombopoiesis [17], and the T-cell-mediated destruction of platelets [18,19]; each pathogenic mechanism plays an independent role in generating thrombocytopenia (Figure 1). syndrome, rheumatoid arthritis, or an immunodeficiency state), a hematological condition (chronic lymphocytic leukemia, large granular lymphocytic leukemia, lymphoma, or autoimmune lymphoproliferative syndrome), or following therapy with drugs such as heparin and quinidine [5][6][7][8][9][10][11]. In children, it often occurs after a viral infection and is selflimiting in 80% of cases.…”

“…In adults, 80% of newly diagnosed patients have primary ITP, which is characterized by isolated thrombocytopenia. Secondary ITP is triggered or associated with another disease, such as a chronic infection (Helicobacter pylori, human immunodeficiency virus-HIV, hepatitis C virus-HCV, or cytomegalovirus-CMV), an autoimmune disease (lupus erythematosus, antiphospholipid syndrome, rheumatoid arthritis, or an immunodeficiency state), a hematological condition (chronic lymphocytic leukemia, large granular lymphocytic leukemia, lymphoma, 2 of 20 or autoimmune lymphoproliferative syndrome), or following therapy with drugs such as heparin and quinidine [5][6][7][8][9][10][11]. In children, it often occurs after a viral infection and is self-limiting in 80% of cases.…”