title: Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient.
abstract: A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura (ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack of tuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Renata dos Santos
authors.initials: Rdos S
authors.lastname: Lugao
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Marina Pamponet
authors.initials: MP
authors.lastname: Motta
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Matheus Freitas Cardoso
authors.initials: MF
authors.lastname: de Azevedo
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Roque Gabriel Rezende
authors.initials: RG
authors.lastname: de Lima
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Flávia de Azevedo
authors.initials: Fde A
authors.lastname: Abrantes
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Flair José
authors.initials: FJ
authors.lastname: Carrilho
authors.affiliation: Renata dos Santos Lugao, Marina Pamponet Motta, Matheus Freitas Cardoso de Azevedo, Roque Gabriel Rezende de Lima, Flair José Carrilho, Daniel Ferraz de Campos Mazo, Hepatology Branch, Clinical Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, Brazil.
authors.forename: Daniel Ferraz de Campos
authors.initials: DF
authors.lastname: Mazo
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D003113:Colonoscopy; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007410:Intestinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D013256:Steroids
keywords: Immune thrombocytopenic purpura; Intestinal tuberculosis; Liver transplant; Thrombocytopenia; Tuberculosis