Sugiura Tsutomu, Yamamoto Kazuhiko, Murakami Kazuhiro, Horita Satoshi, Matsusue Yumiko, Nakashima Chie, Kirita Tadaaki
Dept. of Oral and Maxillofacial Surgery, Nara Kasuga Hospital, Nara, Japan.
Dept. of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan.
J Dent (Shiraz). 2018 Jun;19(2):159-163.
Immune thrombocytopenic purpura (ITP) is an immune-mediated acquired disease found in both adults and children. It is characterized by transient or persistent decreases in the platelet count. We report a case of ITP detected based on oral hemorrhagic symptoms. The patient was a 79-year-old female with no significant past medical history. She presented with sudden onset of gingival bleeding and hemorrhagic bullae on the buccal mucosa. Gingival bleeding was difficult to control. Laboratory tests revealed severe thrombocytopenia with a platelet count as low as 2000/μL. Under a provisional diagnosis of a hematological disorder, she was referred to a hematologist. A peripheral smear showed normal-sized platelets. A bone marrow examination revealed increased numbers of megakaryocytes without morphologic abnormalities. The patient was diagnosed with ITP and treated with a combination of pulsed steroid therapy and high-dose immunoglobulin therapy. However, her severe thrombocytopenia was refractory to these treatments. Then, a thrombopoietin receptor agonist was begun as a second-line treatment. Her platelets rapidly increased, and no bleeding complications were reported. Because oral symptoms can be one of the initial manifestations of ITP, dentists should be familiar with the clinical appearance of ITP, and attention must be paid to detect and diagnose unidentified cases.
免疫性血小板减少性紫癜（ITP）是一种在成人和儿童中均有发现的免疫介导的获得性疾病。其特征为血小板计数短暂或持续下降。我们报告一例基于口腔出血症状而确诊的ITP病例。患者为一名79岁女性，既往无重大病史。她出现牙龈突然出血以及颊黏膜出血性大疱。牙龈出血难以控制。实验室检查显示严重血小板减少，血小板计数低至2000/μL。在初步诊断为血液系统疾病后，她被转诊至血液科医生处。外周血涂片显示血小板大小正常。骨髓检查显示巨核细胞数量增多但无形态异常。该患者被诊断为ITP，并接受了脉冲式类固醇疗法和大剂量免疫球蛋白疗法联合治疗。然而，她的严重血小板减少对这些治疗无效。随后，开始使用血小板生成素受体激动剂作为二线治疗。她的血小板迅速增加，且未报告出血并发症。由于口腔症状可能是ITP的初始表现之一，牙医应熟悉ITP的临床表现，并且必须注意检测和诊断未确诊的病例。
