title: Immune thrombocytopenia secondary to tuberculosis: a case and review of literature.
abstract: Immune thrombocytopenia (ITP) is an auto-immune condition that results in isolated thrombocytopenia associated with possibly lethal haemorrhage. In its secondary form, ITP can be triggered by many infectious and non-infectious conditions. Secondary ITP associated with tuberculosis (TB) has rarely been described in the literature. We report on a 22-year-old patient presenting with hypermenorrhoea and petechiae due to ITP secondary to tuberculous lymphadenitis. Normalisation of thrombocytopenia was only achieved after initiation of anti-tuberculosis treatment following failure of thrombocyte substitution and immune-modulatory treatment. A search of the literature available on TB-associated ITP identified 50 cases published between 1964 and 2016. We reviewed all cases using suggested case definitions on the likelihood of association between ITP and TB. A broad spectrum of TB sites was reported to be associated with ITP, and anti-tuberculosis treatment was the most effective therapy for platelet count normalisation. Time from initiation of anti-tuberculosis treatment to platelet count recovery ranged from 2 days to 3 months. In endemic regions, TB should be considered as an underlying cause of ITP. Early diagnosis of TB and initiation of anti-tuberculosis treatment appears crucial for rapid platelet count recovery, and can reduce the risks associated with long-term immunosuppression, transfusions and the time at risk for haemorrhage.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: S F
authors.initials: SF
authors.lastname: Weber
authors.affiliation: Department of Paediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Berlin Institute of Health, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Bélard
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: S
authors.initials: S
authors.lastname: Rai
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India.
authors.forename: R
authors.initials: R
authors.lastname: Reddy
authors.affiliation: Department of Pathology, Kasturba Medical College, Manipal University, Manipal.
authors.forename: S
authors.initials: S
authors.lastname: Belurkar
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India, Manipal McGill Center for Infectious Diseases, Manipal, India.
authors.forename: K
authors.initials: K
authors.lastname: Saravu
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents