Abstract
Idiopathic thrombocytopenia (ITP) is a bleeding disorder involving the destruction of platelets by the immune system. Systemic amyloidosis is another bleeding disorder involving amyloid deposits that create defects in coagulation and increased prothrombin and thrombin times. We report a 52-year-old man with ITP and new two-month-duration, painless gross hematuria without clot formation resulting in amyloidosis involving the ureterovesical area of the bladder. He had osteopenia, hypertension, and moderate thrombocytopenia due to ITP diagnosed 7 years previously. Cystoscopic examination with urine cytology and computed tomography imaging detected a 2-cm protruding solid bladder mass involving the left ureteral orifice and trigone and left mild hydroureteronephrosis, suggesting bladder cancer. Transurethral resection of the bladder mass was performed to confirm amyloidosis involvement in the ureterovesical junction of the bladder and ureter. Four weeks postoperatively, intermittent gross hematuria remained; hence, left ureteroneocystostomy was performed. Regular follow-up showed no signs of hematuria or intravesical recurrences for 14 months.
Highlights
Immune thrombocytopenia (ITP), previously called idiopathic thrombocytopenia purpura, results from systemic antibody-mediated platelet destruction combined with impaired platelet production and comprises a syndrome of diverse immune-mediated disorders with differing pathogeneses, natural histories, and responses to therapy [1]
We report a case of a 52-year-old man with ITP and amyloidosis of the bladder
The patient had underlying ITP presenting with recurrent two-month-duration gross hematuria and mild hydronephroureterosis treated with transurethral resection of the bladder amyloidosis and subsequent ureteroneocystostomy of the ureter amyloidosis
Summary
Immune thrombocytopenia (ITP), previously called idiopathic thrombocytopenia purpura, results from systemic antibody-mediated platelet destruction combined with impaired platelet production and comprises a syndrome of diverse immune-mediated disorders with differing pathogeneses, natural histories, and responses to therapy [1]. A standard goal of therapy of ITP is to increase the platelet count to prevent subsequent hemorrhaging. Amyloidosis is another systemic disease affecting many organs, including the genitourinary tract that is characterized by the deposition and accumulation of hyaline, eosinophilic, and proteinaceous materials in various tissues. Localized amyloidosis of the genitourinary tract is a rare entity characterized by small pseudotumors localized in the renal pelvis, ureter, or bladder [2]. Very few case reports of concomitant ITP and amyloidosis in diverse organs such as the lung [3] and skin [4] exist. We report a case of a 52-year-old man with ITP and amyloidosis of the bladder. The patient had underlying ITP presenting with recurrent two-month-duration gross hematuria and mild hydronephroureterosis treated with transurethral resection of the bladder amyloidosis and subsequent ureteroneocystostomy of the ureter amyloidosis
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