Concomitant Immune Thrombocytopenic Purpura and Crohn’s Disease

Abstract

The coexistence of immune (idiopathic) thrombocytopenic purpura (ITP) and Crohn's disease (CD) is rare. We performed a review of cases of concomitant ITP and CD in the English and Japanese literature. Among 17 identified cases of concomitant ITP and CD, ITP was initially diagnosed in four cases and CD was initially diagnosed first in six cases. Simultaneous diagnoses were reported in the remaining seven cases. No fatalities were reported in any of the 17 cases. However, resistance or transient responses to standard therapies, such as glucocorticoids or intravenous immunoglobulin (IVIG), and splenectomy for the treatment of ITP were reported in a number of concomitant cases. Moreover, the administration of anti-tumor necrosis factor (TNF)-alpha antibodies was a commonly considered pharmacological therapy in cases of concomitant ITP and CD.

Association of Immune Thrombocytopenia and Inflammatory Bowel Disease in Children

“…IBDs represent a spectrum of enteropathies, including CD, UC, and IBDU, with a variable level of seriousness and a wide range of associated autoimmune disorders whose cumulative prevalence is 8.2% to 10.5% [ 18 ]. Autoimmune antibody-related hematologic diseases, such as autoimmune hemolytic anemia, autoimmune neutropenia, and ITP [ 5 , 6 , 19 , 20 , 21 ], have been occasionally reported in patients with IBD: up to now, fewer than 80 cases of IBD/ITP association of every age have been published, about two-thirds being UC [ 1 , 7 , 8 ]. There is a scarcity of literature about the association between IBD and ITP in childhood and, other than the cohort of 8 patients of Higuchi [ 12 ], to the best of our knowledge, only 15 other IBD/ITP pediatric patients have been published, mostly in single case reports [ 9 , 10 , 11 , 18 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

“…Many extraintestinal autoimmune manifestations are reported in inflammatory bowel disease (IBD), the most common hematological type being autoimmune hemolytic anemia [ 1 , 2 , 3 , 4 ]. In rare cases, immune thrombocytopenia (ITP), a hematological disorder characterized by the production of autoantibodies against platelets, can be associated [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]: only a few patients are of pediatric age [ 1 , 12 ]. In this retrospective study, we analyzed the largest series of children affected by both ITP and IBD.…”