Wada Hiroshi, Sakashita Takuto
Department of Respiratory Medicine, National Hospital Organization Higashi-ohmi General Medical Center, 255 Gochi, Higashi-ohmi, Shiga, 527-8505, Japan.
Respir Med Case Rep. 2020 Dec 9;31:101320. doi: 10.1016/j.rmcr.2020.101320. eCollection 2020.
An 80-year-old woman was diagnosed with miliary tuberculosis. Laboratory findings showed marked thrombocytopenia (3000/μl). Immune thrombocytopenia (ITP) was diagnosed because platelet transfusion was ineffective, and bone marrow puncture demonstrated a normal number of megakaryocytes. Anti-tuberculosis treatment was started promptly, followed by prednisolone 20 mg. However, the platelet count did not increase. The effect of high-dose intravenous immunoglobulin was temporary. She was not responded to prednisolone, and eltrombopag 12.5 mg was added. The eltrombopag dose was increased by 12.5 mg every two weeks. When the eltrombopag dose reached 50 mg, the thrombocytopenia improved sufficiently (44,000/μl). She didn't have any severe bleeding and thrombotic complications. The treatment of tuberculosis went well and there was no side effect of anti-tuberculosis treatment. Eltrombopag can be a useful treatment for ITP due to tuberculosis.
一名80岁女性被诊断为粟粒性肺结核。实验室检查结果显示明显的血小板减少（3000/μl）。由于血小板输注无效且骨髓穿刺显示巨核细胞数量正常，故诊断为免疫性血小板减少症（ITP）。立即开始抗结核治疗，随后给予泼尼松龙20mg。然而，血小板计数并未增加。大剂量静脉注射免疫球蛋白的效果是暂时的。她对泼尼松龙无反应，遂加用艾曲泊帕12.5mg。每两周将艾曲泊帕剂量增加12.5mg。当艾曲泊帕剂量达到50mg时，血小板减少症得到充分改善（44,000/μl）。她没有出现任何严重出血和血栓形成并发症。抗结核治疗进展顺利，且无抗结核治疗的副作用。艾曲泊帕可作为治疗结核所致ITP的有效方法。
