Tuberculosis-associated Immune Thrombocytopenia: A Case Report
Identifieur interne : 000845 ( Ncbi/Merge ); précédent : 000844; suivant : 000846Tuberculosis-associated Immune Thrombocytopenia: A Case Report
Auteurs : Reem J. Al Argan [Arabie saoudite] ; Abdulmohsen H. Al Elq [Arabie saoudite]Source :
- Saudi Journal of Medicine & Medical Sciences [ 1658-631X ] ; 2018.
Abstract
Various hematological manifestations are known to occur with tuberculosis (TB), but its association with immune thrombocytopenia is uncommon and not well recognized. Here, the case of a 39-year-old male who presented with a history of epistaxis and hematuria is described. The patient was found to have diffuse lymphadenopathy both clinically and radiologically. He was diagnosed with immune thrombocytopenia; however, there was a delay in the diagnosis of TB because of the patient's refusal of lymph node biopsy and late recognition of the association between TB and immune thrombocytopenia. Treatment with steroids without antituberculosis medications may have led to reactivation and dissemination of tuberculous infection in this patient. Later, the patient was readmitted with a suspected community-acquired pneumonia and the sputum smear was positive for acid-fast bacilli. Unfortunately, the patient died after he developed sepsis and multiorgan failure. The purpose of this case report is to highlight this rare combination and create awareness among clinicians to consider TB as an underlying etiology of immune thrombocytopenia, especially if there are other associated physical findings such as the presence of lymphadenopathy.
Url:
DOI: 10.4103/sjmms.sjmms_140_16
PubMed: 30787844
PubMed Central: 6196693
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<front><div type="abstract" xml:lang="en"><p>Various hematological manifestations are known to occur with tuberculosis (TB), but its association with immune thrombocytopenia is uncommon and not well recognized. Here, the case of a 39-year-old male who presented with a history of epistaxis and hematuria is described. The patient was found to have diffuse lymphadenopathy both clinically and radiologically. He was diagnosed with immune thrombocytopenia; however, there was a delay in the diagnosis of TB because of the patient's refusal of lymph node biopsy and late recognition of the association between TB and immune thrombocytopenia. Treatment with steroids without antituberculosis medications may have led to reactivation and dissemination of tuberculous infection in this patient. Later, the patient was readmitted with a suspected community-acquired pneumonia and the sputum smear was positive for acid-fast bacilli. Unfortunately, the patient died after he developed sepsis and multiorgan failure. The purpose of this case report is to highlight this rare combination and create awareness among clinicians to consider TB as an underlying etiology of immune thrombocytopenia, especially if there are other associated physical findings such as the presence of lymphadenopathy.</p>
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<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
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<title-group><article-title>Tuberculosis-associated Immune Thrombocytopenia: A Case Report</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Al Argan</surname>
<given-names>Reem J.</given-names>
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<given-names>Abdulmohsen H.</given-names>
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<aff id="aff1">Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia</aff>
<author-notes><corresp id="cor1"><bold>Address for correspondence:</bold>
Dr. Reem J. Al Argan, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam P.O. Box 2208, Khobar 31952, Saudi Arabia. E-mail: <email xlink:href="rjalarqan@iau.edu.sa">rjalarqan@iau.edu.sa</email>
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<pub-date pub-type="ppub"><season>Sep-Dec</season>
<year>2018</year>
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<pub-date pub-type="epub"><day>14</day>
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<volume>6</volume>
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<permissions><copyright-statement>Copyright: © 2018 Saudi Journal of Medicine & Medical Sciences</copyright-statement>
<copyright-year>2018</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/4.0"><license-p>This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.</license-p>
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<abstract><p>Various hematological manifestations are known to occur with tuberculosis (TB), but its association with immune thrombocytopenia is uncommon and not well recognized. Here, the case of a 39-year-old male who presented with a history of epistaxis and hematuria is described. The patient was found to have diffuse lymphadenopathy both clinically and radiologically. He was diagnosed with immune thrombocytopenia; however, there was a delay in the diagnosis of TB because of the patient's refusal of lymph node biopsy and late recognition of the association between TB and immune thrombocytopenia. Treatment with steroids without antituberculosis medications may have led to reactivation and dissemination of tuberculous infection in this patient. Later, the patient was readmitted with a suspected community-acquired pneumonia and the sputum smear was positive for acid-fast bacilli. Unfortunately, the patient died after he developed sepsis and multiorgan failure. The purpose of this case report is to highlight this rare combination and create awareness among clinicians to consider TB as an underlying etiology of immune thrombocytopenia, especially if there are other associated physical findings such as the presence of lymphadenopathy.</p>
</abstract>
<kwd-group><kwd>Immune thrombocytopenia</kwd>
<kwd>pulmonary tuberculosis</kwd>
<kwd>tuberculous lymphadenitis</kwd>
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