Lugito Nata Pratama Hardjo, Lorens Jane Olivia, Kwenandar Jessica, Kurniawan Andree
Internal Medicine Department, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman, Lippo Karawaci, Tangerang, Banten 15811, Indonesia.
Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman, Lippo Karawaci, Tangerange, Banten 15811, Indonesia.
Oxf Med Case Reports. 2019 Dec 9;2019(11):486-489. doi: 10.1093/omcr/omz119. eCollection 2019 Nov.
The multifactorial mechanisms of immune thrombocytopenia (ITP) in patients with human immunodeficiency virus (HIV) and tuberculosis (TB) could be caused by HIV, TB or anti-TB drugs. No patients with HIV and opportunistic infection of miliary pulmonary TB who developed thrombocytopenia after treatment with anti-TB drugs have been reported. A 47-year-old woman with HIV/acquired immunodeficiency syndrome and miliary TB with normal platelet count (229 000/μL) started anti-TB drugs (rifampicin, isoniazid, pyrazinamide and ethambutol). After 10 days of treatment, her platelet count was low (17 000/μL). As rifampicin and isoniazid were stopped and intravenous methylprednisolone was given, her platelet count began to increase. After more than a month, her platelet count was normal (192 000/μL) and she started antiretrovirals. This improved platelet count after high-dose methylprednisolone is suggestive of ITP; however, the dilemma is whether it was rifampicin alone that caused ITP or did HIV and disseminated TB infection also play a role?
人类免疫缺陷病毒（HIV）合并结核病（TB）患者免疫性血小板减少症（ITP）的多因素机制可能由HIV、TB或抗结核药物引起。目前尚无关于HIV合并粟粒性肺结核机会性感染且在抗结核药物治疗后出现血小板减少症患者的报道。一名47岁患有HIV/获得性免疫缺陷综合征且粟粒性结核的女性，血小板计数正常（229 000/μL），开始使用抗结核药物（利福平、异烟肼、吡嗪酰胺和乙胺丁醇）治疗。治疗10天后，她的血小板计数降低（17 000/μL）。停用利福平和异烟肼并给予静脉注射甲泼尼龙后，她的血小板计数开始上升。一个多月后，她的血小板计数恢复正常（192 000/μL），并开始接受抗逆转录病毒治疗。高剂量甲泼尼龙治疗后血小板计数改善提示为ITP；然而，困境在于究竟是利福平单独导致了ITP，还是HIV和播散性结核感染也起了作用？
