Dal Mehmet Sinan, Dal Tuba, Tekin Recep, Bodakçi Erdal, Düzköprü Yakup, Ayyildiz Mehmet Orhan
Department of Hematology, Dicle University, Diyarbakir, Turkey.
Infez Med. 2013 Mar;21(1):50-5.
Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. We report a case of immune thrombocytopenic purpura due to splenic tuberculosis. Our case was a 58-year-old female with headache, gum bleeding, redness in legs, and ecchymoses on the arms for 10 days. On admission to hospital, laboratory tests were as follows: platelet count 6.000/mmc (150 000-450 000), haemoglobin: 12 g/dl, WBC: 8000/mm3, erythrocyte sedimentation rate: 58 mm/h and C-reactive protein was in normal ranges. After standard laboratory tests, the patient was diagnosed with idiopathic thrombocytopenic purpura. The patient presented abdominal lymphadenopathies and spleen in normal size in radiological examinations. Diagnostic laparotomy and splenectomy and lymph node excision was performed and splenic tuberculosis was detected in pathologic and microbiologic examination. The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.
尽管医学有了显著进步，但结核病仍是最常见且致命的传染病之一。脾结核是肺外结核的一种罕见形式。免疫性血小板减少症与脾结核相关的病例数量有限。我们报告一例因脾结核导致的免疫性血小板减少性紫癜病例。我们的病例是一名58岁女性，头痛、牙龈出血、腿部发红及手臂瘀斑10天。入院时实验室检查结果如下：血小板计数6000/mmc（150000 - 450000），血红蛋白：12g/dl，白细胞：8000/mm³，红细胞沉降率：58mm/h，C反应蛋白在正常范围内。经过标准实验室检查，患者被诊断为特发性血小板减少性紫癜。患者在影像学检查中出现腹部淋巴结肿大，脾脏大小正常。进行了诊断性剖腹术、脾切除术及淋巴结切除术，病理和微生物学检查发现脾结核。患者通过单采血小板悬液、静脉注射免疫球蛋白及抗结核治疗成功治愈。总之，对于有发热、腹部淋巴结肿大及免疫性血小板减少性紫癜的患者应怀疑脾结核。组织病理学检查仍是确诊的理想方法，微生物学检查可适当辅助。
