title: Immune thrombocytopenic purpura in patients with ulcerative colitis.
abstract: Extraintestinal manifestations of ulcerative colitis (UC) are well known, but immunologically mediated hematological diseases are relatively rare. We describe two cases of immune thrombocytopenic purpura (ITP) associated with preexisting UC. Our patients had typical symptoms of UC, and endoscopy showed pancolitis. During treatment with 5-aminosalicylic acid and steroids, severe thrombocytopenia was noted. ITP was diagnosed based on a normal to high number of megakaryocytes in the bone marrow, positive autoantibody to platelet membrane antigen, and absence of splenomegaly. Medical treatment, including increased dosage of steroids, failed to control UC and ITP in both patients. In the first patient, the platelet count recovered after colectomy, while the second patient died of a cerebral hemorrhage. We stress that a diagnosis of ITP should be considered for thrombocytopenia in patients with UC, especially those showing extensive and significant colonic inflammation, and that colectomy of UC might resolve resistant ITP.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mizuta
authors.forename: Hajime
authors.initials: H
authors.lastname: Isomoto
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kadokawa
authors.forename: Yuko
authors.initials: Y
authors.lastname: Akazawa
authors.forename: Shunzen
authors.initials: S
authors.lastname: Chin
authors.forename: Yusei
authors.initials: Y
authors.lastname: Kanazawa
authors.forename: Fuminao
authors.initials: F
authors.lastname: Takeshima
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Omagari
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Murase
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagoe
authors.forename: Ikuo
authors.initials: I
authors.lastname: Murata
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology*