Abstract
The association of immune thrombocytopenic purpura and tuberculosis is extremely rare. We presented a case with tuberculous lymphadenopathy and immune-mediated thrombocytopenia, the complete remission with anti-tuberculous therapy, and partial response to immunoglobulin and steroid suggested a causal relationship between the two conditions.
Highlights
Immune thrombocytopenic purpura is a diagnosis of exclusion, but many disorders like retroviral infections, autoimmune disorders, lymphoproliferative disorders, and primary immunodeficiency have been associated with this idiopathic disease
Literature review documented few cases with isolated thrombocytopenia associated with tuberculosis [3,4]
We present a case of tuberculous lymphadenopathy with isolated thrombocytopenia
Summary
Immune thrombocytopenic purpura is a diagnosis of exclusion, but many disorders like retroviral infections, autoimmune disorders, lymphoproliferative disorders, and primary immunodeficiency have been associated with this idiopathic disease. We present a case of tuberculous lymphadenopathy with isolated thrombocytopenia. A twenty-one-year Indian male shepherded presented to the emergency department with nose and gum bleeding for 2 days and skin rash on lower extremities for one day. The patient reported painful, gradually increasing swelling on his lateral side of the upper neck during the last month associated with fever, chills, unexplained loss of weight, and sputum with streaks of blood and no bleeding from other sites. Admission full blood count showed: platelets of 5000, hemoglobin 9.9 grams/dl, and white cell count of 6.090. Excisional lymph node biopsy after unremarkable ENT and maxillofacial consultation was taken and revealed non-caseating granuloma diagnostic of tuberculous lymphadenopathy (Figure 3) and the patient was started, isoniazid, ethambutol, pyrazinamide, pyridoxine, and ciprofloxacin in the usual doses, with dramatic improvement, rifampicin was introduced in place of ciprofloxacin. The patient is on regular follow up and is off specific treatment for immune thrombocytopenic purpura
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