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A Case of Immune Thrombocytopenia Associated With Pulmonary Tuberculosis FREE TO VIEW

Eguakhide Inegbenebor, MD; Nibal Saad, MD; Pornchai Leelasinjaroen, MD; Riad Khatib, MD
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St John Hospital and Medical Center, Detroit, MI

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

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