Fan Xiaoli, Chen Liyu, Yang Jingyu, Feng Ping
From the Department of Gastroenterology and Hepatology (XF); Center for Infectious Diseases (LC, JY, PF), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2016 Mar;95(12):e3103. doi: 10.1097/MD.0000000000003103.
Drug-associated thrombocytopenia is common and curable, but there were few reports about entecavir-associated thrombocytopenia.We report here a case of a 65-year-old female patient with decompensated cirrhosis. The patient developed a fatal thrombocytopenia while under entecavir treatment. After she received entecavir treatment for 4 days, the patient's platelet count dropped significantly to 1 × 10/L, accompanied with a manifestation of mild sclera bleeding. All diagnostic data suggested an entecavir-induced immunological thrombocytopenia. The patient eventually fully recovered after treated with daily intravenous immunoglobulin infusions.Actually, there were only a handful of reports that children or adults with chronic hepatitis B developed a thrombocytopenia due to nucleoside analogue medication. Timeliness of intravenous immunoglobulin infusion could stop the fatal bleeding for patients with entecavir-associated immunological thrombocytopenia. Hence, early diagnosis and treatment are recommended. Our case suggested that the platelet count should be monitored regularly in patients with decompensated cirrhosis with underline immunological disease while treated with ETV.
药物相关性血小板减少症很常见且可治愈，但关于恩替卡韦相关性血小板减少症的报道很少。我们在此报告一例65岁失代偿期肝硬化女性患者。该患者在接受恩替卡韦治疗期间出现致命性血小板减少症。在她接受恩替卡韦治疗4天后，患者血小板计数显著降至1×10⁹/L，伴有轻度巩膜出血表现。所有诊断数据提示为恩替卡韦诱导的免疫性血小板减少症。该患者经每日静脉输注免疫球蛋白治疗后最终完全康复。实际上，仅有少数报告称慢性乙型肝炎儿童或成人因核苷类似物用药出现血小板减少症。及时静脉输注免疫球蛋白可阻止恩替卡韦相关性免疫性血小板减少症患者的致命性出血。因此，建议早期诊断和治疗。我们的病例提示，在失代偿期肝硬化且有潜在免疫性疾病的患者接受恩替卡韦治疗时，应定期监测血小板计数。
