Martinez Ashley R, Paul Megan Rose, Kuo Dennis John
Department of Pediatrics, University of California, San Diego, California, USA.
Department of Pediatric Hematology-Oncology, University of California, San Diego, California, USA.
BMJ Case Rep. 2017 Sep 25;2017:bcr-2017-221947. doi: 10.1136/bcr-2017-221947.
A 13-year-old male patient with a history of pre-B cell acute lymphoblastic leukaemia (ALL) with isolated central nervous system relapse on maintenance chemotherapy presented with severe thrombocytopenia refractory to platelet transfusions. The patient showed only modest responses to two courses of intravenous immunoglobulin and steroids. He was found to be positive for cytomegalovirus (CMV) with modest viral load. His thrombocytopenia normalised with rituximab therapy and CMV treatment supporting the diagnosis of CMV-associated immune thrombocytopenic purpura (ITP). Following treatment, the patient continued to have a stable platelet count well above the threshold for transfusions. He continued to be intermittently treated for CMV when viral loads became detectable. This report discusses the unique management considerations of ITP in a patient undergoing therapy for ALL with a review of previously reported cases and discusses the possibility of CMV viraemia as a modulating factor.
一名13岁男性患者，有前B细胞急性淋巴细胞白血病（ALL）病史，在维持化疗期间出现孤立性中枢神经系统复发，并伴有严重血小板减少症，对血小板输注难治。该患者对两个疗程的静脉注射免疫球蛋白和类固醇仅表现出适度反应。发现他巨细胞病毒（CMV）呈阳性，病毒载量中等。他的血小板减少症通过利妥昔单抗治疗和CMV治疗得以恢复正常，支持CMV相关免疫性血小板减少性紫癜（ITP）的诊断。治疗后，患者的血小板计数持续稳定，远高于输血阈值。当病毒载量可检测到时，他继续接受CMV的间歇性治疗。本报告讨论了ALL治疗患者中ITP的独特管理考量，并回顾了先前报道的病例，并讨论了CMV病毒血症作为调节因素的可能性。
