EFFECT OF alpha-INTERFERON IN A CHILD WITH CHRONIC REFRACTORY IDIOPATHIC THROMBOCYTOPENIC PURPURA

Abstract

A girl, 3 years and 9 months old, suffered from idiopathic thrombocytopenic purpura (ITP), which was evidenced with extensive petechiae and ecchymoses at the onset of a segmental pneumonia of the left lung. High doses of intravenous c -globulin (IVIG: 1 g/kg day ¡ 1 £ 2 days) were administered to control severe epistaxis without achieving a signi® cant increase in platelet count. Over the following 11 months the child remained severely thrombocytopenic and presented with frequent hemorrhagic manifestations (petechiae, ecchymoses, hematuria). Therapeutic attempts with IVIG, prednisolone in conventional doses (2 mg/kg day ¡ 1 ), ascorbic acid, or high doses of methylprednisolone [1] failed to induce a signi® cant and permanent increase in platelets. The short duration of ITP and the patients young age restricted us from preceding to a selective splenectomy. From experience we know that a small number of children with chronic problematic ITP may remit spontaneously or after therapeutic intervention several years from the onset of the disease (even 10 years later) [2]. Besides, splenectomy is known to be associated with a higher incidence of fulminant septicemia in children less than 5 years of age than in older children or adults [3,4]. For those reasons and to give our patient a better chance of remission, we decided to treat her with a course of a -interferon (a -IFN) subcutaneously at a dosage of 3,000,000 IU/m 2 SQ 3 times a week for 4 weeks [5] and subsequently once a week. A prompt increase in platelets was ® rst observed the fourth day from