Idiopathic thrombocytopenic purpura treated with steroid therapy does not prevent acute myocardial infarction: a case report.
We report the case of a 65-year-old man affected by idiopathic thrombocytopenic purpura, who developed an acute myocardial infarction after 2 years of steroid therapy. Thrombocytopenia was initially recognized 11 years earlier, and became severe during the past 2 years [platelets (PLTS) 10000-30000/microl]. He was treated with steroids, initially to perform a surgical procedure (prednisone 75 mg/day), subsequently to maintain a platelet count of about 50000/microl (prednisone 12.5 mg/day). After 1 year of treatment, he began to complain about exertional angina and dyspnea. His blood pressure became elevated and cholesterol level raised. The exercise electrocardiogram, previously manifesting ischaemic changes, normalized after 1 month of steroid wash-out; however, steroid therapy was reinstituted (prednisone 5 mg per day). One year later, he suffered an infero-lateral non-Q-wave myocardial infarction. It seems likely that the severe coronary atherosclerosis present in our patient developed despite a low platelet count, under the spur of a heavier risk factor profile. Steroid therapy could have had a role as a precipitating agent of the acute event, and the opportunity of alternative treatments is considered.
Paolini
R
R
Department of Medicine, Rovigo General Hospital, Italy.
Zamboni
S
S
Ramazzina
E
E
Zampieri
P
P
Cella
G
G
D000368:Aged; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology*; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*
D013256:Steroids