Corticosteroid Resistant Idiopathic Thrombocytopenic purpura: Case report and literature review

摘要

Idiopathic thrombocytopenia purpura (ITP), also known as immune thrombocytopenic purpura, is defined as isolated thrombocytopenia with normal bone marrow aspirate and the absence of other causes of thrombocytopenia. The first line of treatment of ITP is corticosteroids. We present a case of a patient who was diagnosed with ITP but his ITP was resistant to corticosteroids. Introduction The differential diagnoses of a patient with decreased number of platelets: Disorder of platelet production Viral Infections (Rubella, Mumps, varicella, Hep C, EBV, HIV) Bone marrow disorder (Hypoplasia, megakaryocytic aplasia, Alcohol induced marrow suppression) Disorders of Platelet destruction: Idiopathic thrombocytopenic purpura (ITP) Thrombotic thrombocytopenic purpura (TTP) Disseminated intravascular coagulation (DIC) Pseudo thrombocytopenia Hypersplenism Here is illustrated a case of decreased platelets fitting with diagnosis of steroid resistant Idiopathic thrombocytopenic purpura (ITP). History A sixty year old Hispanic male presented to us with the following complaints: Flu like symptoms and sore throat from last 2 days. Fever and chills from last 2 days. Pin Point red spots on different parts of body from last 1 day. One episode of epistaxis, one day before presentation. There is no history of chest pain and shortness of breath, hemoptysis, and hematuria, black stools, bleeding per rectum or bleeding from any part of the body, previous history of blood transfusion, drug abuse and recent vaccinations.He was diagnosed with hypertension 10 years back but he never used any anti-hypertensive medicines. He used to take 20 bottles of bear per day from last 20 years and 1 pack of cigarettes from last 39 years.He has no history of any hematological problem in his family. On Examination A 60 year old Hispanic male, of average build with no obvious distress. His blood pressure at time of presentation was 200/120. He had diffuse petechial hemorrhage scattered over the whole body and bruises on both left and right lower legs. Petechial hemorrhages were also noted on the palate. There was no hepato-spleenomegaly.