Isolated gastric mucosal hemorrhages in idiopathic thrombocytopenic purpura

Dang, Shyam; Atiq, Muslim; Julka, Rahul N.; Olden, Kevin W.; Aduli, Farshad

doi:10.1016/j.gie.2009.03.003

Cited by 5 publications

(9 citation statements)

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“…A total of 43 cases of HIV-positive patients with pancreatic TB (including the present case) were reviewed [2, . Of these cases, 40 were primarily analyzed [2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33][34][35][36][37][38] . Table 1 illustrates the clinical characteristics of the pancreatic TB patients with AIDS.…”

Section: Discussionmentioning

confidence: 99%

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Pancreatic tuberculosis with acquired immunodeficiency syndrome: A case report and systematic review

Meesiri¹

2012

WJG

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Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma, lymphoma, cystic neoplasia, retroperitoneal tumors, pancreatitis or pseudocysts. Here, I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia, fever, weight loss and an epigastric mass. The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome, and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy. The clinical presentation, radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection. I also emphasize the need for both histopathological and microbiological diagnosis via fine-needle aspiration.

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Section: Discussionmentioning

confidence: 99%

“…Gender [2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][30][31][32][34][35][36][37][38] Male 28/39 (71.8) Female 11/39 (28.2) Known HIV-infected cases [2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][25]…”

Section: Clinical Characteristics N (%)unclassified

Pancreatic tuberculosis with acquired immunodeficiency syndrome: A case report and systematic review

Meesiri¹

2012

WJG

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“…Increasing gastric pH may limit degradation of previously formed platelet plugs and decrease proteolytic activity of pepsin on existing thrombi. Proton pump inhibitors in combination with other therapies have been successful for treatment of gastric bleeding in human patients with myelodysplasia and thrombocytopenia or idiopathic thrombocytopenia purpura . Despite this phenomenon, acid suppressants are not routinely administered in humans with immune‐mediated thrombocytopenia (ITP).…”

Section: Evidence To Support Clinical Use Of Gastroprotectants In Dogmentioning

confidence: 99%

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats

Marks

Kook

Papich

et al. 2018

Veterinary Internal Medicne

177

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The gastrointestinal (GI) mucosal barrier is continuously exposed to noxious toxins, reactive oxygen species, microbes, and drugs, leading to the development of inflammatory, erosive, and ultimately ulcerative lesions. This report offers a consensus opinion on the rational administration of GI protectants to dogs and cats, with an emphasis on proton pump inhibitors (PPIs), histamine type‐2 receptor antagonists (H2RAs), misoprostol, and sucralfate. These medications decrease gastric acidity or promote mucosal protective mechanisms, transforming the management of dyspepsia, peptic ulceration, and gastroesophageal reflux disease. In contrast to guidelines that have been established in people for the optimal treatment of gastroduodenal ulcers and gastroesophageal reflux disease, effective clinical dosages of antisecretory drugs have not been well established in the dog and cat to date. Similar to the situation in human medicine, practice of inappropriate prescription of acid suppressants is also commonplace in veterinary medicine. This report challenges the dogma and clinical practice of administering GI protectants for the routine management of gastritis, pancreatitis, hepatic disease, and renal disease in dogs and cats lacking additional risk factors for ulceration or concerns for GI bleeding. Judicious use of acid suppressants is warranted considering recent studies that have documented adverse effects of long‐term supplementation of PPIs in people and animals.

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“…Yet hematologists do not routinely seek evidence for it since it is felt that clinically significant bleeding would likely manifest itself [1]. Most descriptions of occult hemorrhage in ITP literature are case reports and focus on isolated bleeding in the GI or urinary tract [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Occult hemorrhage in children with severe ITP

Flores

Buchanan

2016

American J Hematol

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Little is known about the frequency and significance of clinically unapparent or occult hemorrhage in ITP. Therefore, we prospectively explored the sites and frequency of occult bleeding in children with severe ITP at diagnosis or upon symptomatic relapse in a prospective, single-institution cohort study of patients 18 years of age and a platelet count 10,000/mm 3 . Data collected included bleeding severity assessment, urinalysis, fecal occult blood testing, and non-contrast brain MRI. Stool and urine samples were tested within 7 days of diagnosis or symptomatic relapse. Three months after diagnosis or relapse a noncontrast brain MRI evaluated hemosiderin deposits resulting from prior localized hemorrhage. Fifty-two ITP patients were enrolled with a mean platelet count of 4,000/mm 3 . A significant occurrence of occult hemorrhage was identified in the urine (27%) compared with clinically overt hematuria (0.91%, P < 0.0005). CNS microbleeding in the superficial cortex of the left frontal lobe was identified in one child with occult bleeding in the urinary tract. There was no relationship between occult hemorrhage and bleeding manifestations on physical examination. Occult hemorrhage was not a harbinger of subsequent bleeding. Our findings suggest that occult hemorrhage occurs with greater frequency than overt bleeding in children with severe ITP. CNS microbleeding is a potential risk in this patient population. Assessment of brain microbleeds and microscopic hematuria in this patient population require additional study.

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Isolated gastric mucosal hemorrhages in idiopathic thrombocytopenic purpura

Cited by 5 publications

References 0 publications

Pancreatic tuberculosis with acquired immunodeficiency syndrome: A case report and systematic review

Pancreatic tuberculosis with acquired immunodeficiency syndrome: A case report and systematic review

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats

Occult hemorrhage in children with severe ITP

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