Gupta S, Brennan D C
Department of Nephrology, Washington University, Saint Louis, Missouri, USA.
Department of Nephrology, Washington University, Saint Louis, Missouri, USA.
Transplant Proc. 2016 Jan-Feb;48(1):262-4. doi: 10.1016/j.transproceed.2015.12.004.
Pneumococcal 13-valent conjugate vaccine (PCV13) is used for immunization to prevent invasive disease caused by Streptococcus pneumoniae. Rare cases of idiopathic thrombocytopenic purpura (ITP) after vaccination with PCV13 have been reported.
A case of ITP associated with PCV13 administration in a renal allograft recipient is described. A 77-year-old man presented with bruising at insulin injection sites for 1 week. He had end-stage renal disease and received a kidney transplant 22 months previously. Maintenance immunosuppression included tacrolimus and prednisone.
Physical examination showed normal vital signs and petechial rash in the areas of insulin injections. Laboratory testing resulted in hemoglobin, 11.7 g/dL; white blood cell count, 7700/mm(3); and platelet count, 3000/mm(3) (baseline, 140,000). Workup for infection, hemolysis, and thrombotic thrombocytopenic purpura was negative. Isolated thrombocytopenia was diagnosed as ITP and was attributed to PCV13 vaccination that he had received 1 month ago. He was treated with methylprednisolone, pooled immunoglobulins, and platelet transfusions. Subsequent platelet counts improved to his baseline of 140,000 over a period of 3 weeks. The PCV13 works by generating a T-helper-cell response.
ITP may involve antibody production driven by T-helper cells reacting to platelet surface glycoproteins. This case is unique in that it occurred in a patient who was on immunosuppression with a calcineurin inhibitor and corticosteroids.
13价肺炎球菌结合疫苗（PCV13）用于预防肺炎链球菌引起的侵袭性疾病。已有接种PCV13疫苗后发生特发性血小板减少性紫癜（ITP）的罕见病例报道。
描述了1例肾移植受者接种PCV13后发生ITP的病例。一名77岁男性在胰岛素注射部位出现瘀斑1周。他患有终末期肾病，22个月前接受了肾移植。维持性免疫抑制包括他克莫司和泼尼松。
体格检查显示生命体征正常，胰岛素注射部位有瘀点性皮疹。实验室检查结果为血红蛋白11.7 g/dL；白细胞计数7700/mm³；血小板计数3000/mm³（基线为140,000）。感染、溶血及血栓性血小板减少性紫癜的检查均为阴性。孤立性血小板减少症被诊断为ITP，归因于他1个月前接种的PCV13疫苗。他接受了甲泼尼龙、静脉注射免疫球蛋白和血小板输注治疗。随后血小板计数在3周内恢复至基线水平140,000。PCV13通过产生辅助性T细胞反应发挥作用。
ITP可能涉及辅助性T细胞对血小板表面糖蛋白反应驱动的抗体产生。该病例的独特之处在于发生在一名正在接受钙调神经磷酸酶抑制剂和糖皮质激素免疫抑制治疗的患者身上。
