Tuberculosis Presenting as Immune Thrombocytopenia: A case report and review of the literature

Abstract

Various hematological abnormalities commonly occur in active tuberculosis (TB) but thrombocytopenia is exceedingly rare and immune thrombocytopenic purpura (ITP) is reported in only a few cases. A 28-year-old male presented with thrombocytopenia-induced epistaxis and generalized purpura that did not respond to intravenous immunoglobulin but did resolve after antituberculoustreatment The characteristics of this rarely documented association are reviewed.

Immune Thrombocytopenic Purpura, a rare manifestation of active tuberculosis: Case report

“…The early effect is due to the decrease in vascular permeability, while the late effect involves immunoglobulin G. A blockade of Fc receptors in reticuloendothelial cells and suppression of the production of antibodies and their binding is suggested as a possible mechanism that may be the result of anti-idiotype antibodies that bind to antiplatelet antibodies which modulate the immune response. 4 In this case, methylprednisolone plus immunoglobulin G were administered, achieving significant improvement as seen in the increase on platelet count. 3,10 Steroids as a cornerstone of treatment are continued orally with gradual dose decrease to complete 4-8 weeks, always keeping in mind that the underlying cause must be treated.…”

“…TB‐induced thrombocytopenia is more commonly caused by nonimmunological mechanisms and typically manifests in the context of pancytopenia that develops secondarily to granulomatous bone marrow infiltration. The association between TB and ITP is extremely rare 2,4‐7 . TB most commonly presents with hematological alterations such as anemia, leukocytosis, leukopenia, or pancytopenia 8,9 …”

“…Clinically, it is known that steroids improve purpuric bleeding before the platelet count actually increases. The early effect is due to the decrease in vascular permeability, while the late effect involves immunoglobulin G. A blockade of Fc receptors in reticuloendothelial cells and suppression of the production of antibodies and their binding is suggested as a possible mechanism that may be the result of anti‐idiotype antibodies that bind to antiplatelet antibodies which modulate the immune response 4 …”

Immune Thrombocytopenic Purpura Secondary to Peritoneal Tuberculosis Patient with Anti-Tuberculosis Drug-Induced Liver Injury. A Case Report

“…The ITP in extrapulmonary tuberculosis can be either due to the production of platelet antigen-specific antibodies or platelet surface membrane immunoglobulin G, which is generated by proliferating lymphocytes as a part of the immune response to infection (2). Toxic thrombocytopenia might be related to the direct effect of the infecting organism, the acid-fast bacilli, or of immune complexes on the platelets during the most toxic period of infection (10). Previously suggested mechanisms included the production of antiplatelet antibodies and molecular mimicry during the regular immune response to TB (3).…”

Immune thrombocytopenic purpura secondary to tuberculosis

“…1 A wide spectrum of hematological manifestations of tuberculosis has been observed, although an association with immune thrombocytopenia is quite rare and there have been few reports to date. 2,3 We report the case of an 11-year-old girl diagnosed with tuberculous lymphadenitis induced immune thrombocytopenic purpura, who responded well to anti-tuberculosis therapy and steroids.…”