Weber S F, Bélard S, Rai S, Reddy R, Belurkar S, Saravu K
Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India.
Department of Paediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Berlin Institute of Health, Berlin, Germany.
Int J Tuberc Lung Dis. 2017 Apr 1;21(4):466-470. doi: 10.5588/ijtld.16.0515.
Immune thrombocytopenia (ITP) is an auto-immune condition that results in isolated thrombocytopenia associated with possibly lethal haemorrhage. In its secondary form, ITP can be triggered by many infectious and non-infectious conditions. Secondary ITP associated with tuberculosis (TB) has rarely been described in the literature. We report on a 22-year-old patient presenting with hypermenorrhoea and petechiae due to ITP secondary to tuberculous lymphadenitis. Normalisation of thrombocytopenia was only achieved after initiation of anti-tuberculosis treatment following failure of thrombocyte substitution and immune-modulatory treatment. A search of the literature available on TB-associated ITP identified 50 cases published between 1964 and 2016. We reviewed all cases using suggested case definitions on the likelihood of association between ITP and TB. A broad spectrum of TB sites was reported to be associated with ITP, and anti-tuberculosis treatment was the most effective therapy for platelet count normalisation. Time from initiation of anti-tuberculosis treatment to platelet count recovery ranged from 2 days to 3 months. In endemic regions, TB should be considered as an underlying cause of ITP. Early diagnosis of TB and initiation of anti-tuberculosis treatment appears crucial for rapid platelet count recovery, and can reduce the risks associated with long-term immunosuppression, transfusions and the time at risk for haemorrhage.
免疫性血小板减少症（ITP）是一种自身免疫性疾病，可导致孤立性血小板减少症，并可能伴有致命性出血。在其继发形式中，ITP可由多种感染性和非感染性疾病引发。与结核病（TB）相关的继发性ITP在文献中很少被描述。我们报告了一名22岁的患者，因结核性淋巴结炎继发ITP而出现月经过多和瘀点。在血小板替代治疗和免疫调节治疗失败后，启动抗结核治疗后血小板减少才得以恢复正常。对与TB相关的ITP的现有文献进行检索，共识别出1964年至2016年间发表的50例病例。我们根据关于ITP与TB关联可能性的建议病例定义对所有病例进行了回顾。据报道，广泛的TB部位与ITP相关，抗结核治疗是使血小板计数恢复正常的最有效疗法。从开始抗结核治疗到血小板计数恢复的时间为2天至3个月。在流行地区，应将TB视为ITP的潜在病因。早期诊断TB并启动抗结核治疗对于血小板计数快速恢复似乎至关重要，并且可以降低与长期免疫抑制、输血及出血风险期相关的风险。
