0
Chest Infections |

A Case of Immune Thrombocytopenia Associated With Pulmonary Tuberculosis

Eguakhide Inegbenebor, MD; Nibal Saad, MD; Pornchai Leelasinjaroen, MD; Riad Khatib, MD
Author and Funding Information

St John Hospital and Medical Center, Detroit, MI


Chest. 2014;146(4_MeetingAbstracts):180A. doi:10.1378/chest.1990919
Text Size: A A A
Published online

Abstract

SESSION TITLE: Infectious Disease Student/Resident Case Report Posters III

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Immune thrombocytopenia (ITP) is an acquired disorder characterized by increased platelet destruction by auto antibodies. It is described in many conditions but is rare in tuberculosis. We present a 68 year old lady with a case of immune thrombocytopenia with active pulmonary tuberculosis.

CASE PRESENTATION: We present a 68 year old African American lady with medical history of COPD who presented with 2 week history of cough, weight loss and hemoptysis. No history of fever, or night sweats. She had a history of treatment for tuberculosis 4 years prior to presentation. Examination revealed tachycardia, tachypnea, bibasilar rales and decreased breath sounds. She was found to have isolated thrombocytopenia of 13 000/mm3. The patient was intubated for mental status changes and airway protection and a CT of the head was done and showed multiple areas of infarction with hemorrhage. The platelets dropped to 7000/mm3; her WBC 10600/mm3 and hemoglobin was 12.5 g/dl. She was transfused multiple units of platelets with no change in her platelet count. Disseminated intravascular coagulopathy was excluded. Peripheral smear showed marked decrease in platelet number with normal morphology. HIV, lupus and thyroid dysfunction screens were negative . Blood, sputum and urine cultures were consistently negative .Bronchoalveolar sampling revealed Mycobacterium tuberculosis on smear and confirmed on culture. Thrombocytopenia was thought to be immune mediated secondary to pulmonary tuberculosis. She was started on antituberculosis medication, intravenous immunoglobulin (IVIG) and steroids but she deteriorated and passed away. Autopsy was declined by family.

DISCUSSION: Tuberculosis is often associated with hematological manifestations usually by infiltrative process of bone marrow. The diagnosis of secondary immune mediated thrombocytopenia is based on the finding of an isolated thrombocytopenia, presence of a clinically apparent associated condition, a compatible history, clinical findings, absence of alternate etiology and response to treatment.

CONCLUSIONS: This case represents a rare presentation of pulmonary tuberculosis. Literature review showed tuberculosis associated with immune thrombocytopenia in 15 cases with this as the third case in the USA to our knowledge [1-3]. The aim of presenting this case is to reinforce the awareness of this rare presentation/complication to avoid missing the diagnosis and improve infection control

Reference #1: Al-Majed, S., et al., Tuberculosis presenting as immune thrombocytopenic purpura. Acta haematologica, 1995. 94(3): p. 135-138.

Reference #2: Ghobrial, M. and M. Albornoz, Immune thrombocytopenia: a rare presenting manifestation of tuberculosis. American journal of hematology, 2001. 67(2): p. 139-143

Reference #3: Tsuro, K., et al., Immune thrombocytopenic purpura associated with pulmonary tuberculosis. Internal medicine (Tokyo, Japan), 2005. 45(11): p. 739-742.

DISCLOSURE: The following authors have nothing to disclose: Eguakhide Inegbenebor, Nibal Saad, Pornchai Leelasinjaroen, Riad Khatib

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543