title: A case of gray platelet syndrome masked by immune thrombocytopenia at presentation.
abstract: We report a case of gray platelet syndrome (GPS) associated with immune thrombocytopenia (ITP) at presentation. A 22-year-old male patient presenting with petechiae on his limbs was diagnosed with ITP due to a gradual decrease of his platelet count to a minimum of 26 × 10(9) /liter and an elevated platelet-associated IgG (PA-IgG) level in the absence of any other specific cause of thrombocytopenia. Administration of prednisolone increased his platelet count, but this dropped again to approximately 50 × 10(9) /liter as the dose was tapered, and remained at the same level after the treatment was terminated. Thirteen years later, we reassessed the cause of the thrombocytopenia because the PA-IgG level was found to be within the normal range. There were large hypogranular platelets on the blood film and a deficit of α-granules in the platelets on electron microscopy. On this basis, we diagnosed his thrombocytopenia as GPS. To our knowledge, this is the first report of a GPS case associated with ITP at presentation. This case illustrates the importance of carefully reviewing blood film results in the differential diagnosis of thrombocytopenia.
authors.forename: Nana
authors.initials: N
authors.lastname: Mizuno
authors.forename: Eriko
authors.initials: E
authors.lastname: Kanamori
authors.forename: Hiroko
authors.initials: H
authors.lastname: Saito
authors.forename: Naomi
authors.initials: N
authors.lastname: Murakami
authors.forename: Naoko
authors.initials: N
authors.lastname: Tojo
authors.forename: Shuji
authors.initials: S
authors.lastname: Tohda
mesh_terms: D016824:Antigens, Human Platelet / Q000276:immunology; D001792:Blood Platelets / Q000276:immunology / Q000648:ultrastructure; D003594:Cytoplasmic Granules / Q000648:ultrastructure; D057210:Delayed Diagnosis; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000276:immunology; D055652:Gray Platelet Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D006942:Hypergammaglobulinemia / Q000209:etiology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011693:Purpura / Q000209:etiology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D055815:Young Adult
chemical_list: D016824:Antigens, Human Platelet; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011239:Prednisolone