Saito Makoto, Morioka Masanobu, Izumiyama Koh, Mori Akio, Kondo Takeshi
Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN.
Cureus. 2021 Aug 27;13(8):e17478. doi: 10.7759/cureus.17478. eCollection 2021 Aug.
The treatment of immune thrombocytopenia (ITP) has recently changed; however, each treatment has not only advantages, but also disadvantages, and may have unexpected complications. We describe an instructive case of ITP that was complicated by severe portal vein thrombosis during treatment with eltrombopag, an oral thrombopoietin-receptor agonist (TPO-RA) drug, plus prednisolone (PSL) concomitant splenectomy. A male ITP patient who had been receiving eltrombopag treatment for more than four years at our department underwent a splenectomy at the age of 51. Soon after splenectomy, splenic vein and portal vein thrombosis developed, while splenectomy was ineffective. The patient resumed eltrombopag treatment after thrombosis disappeared. Although fluctuations in PLT were observed, eltrombopag and PSL were used together for a while. Subsequently, lower-limb deep vein thrombosis recurred, and edoxaban tosylate was administered for a total of 8.4 months. More than three years after splenectomy, at the age of 54, abdominal computed tomography (CT) revealed a continuous thrombus extending from the intrahepatic portal vein to the superior mesenteric vein. In patients with ITP in whom splenectomy fails and treatment with a TPO-RA ± PSL needs to be continued, clinicians should be aware of the possibility of abdominal thrombotic adverse events, such as severe portal vein thrombosis, by following-up on CT imaging, not only in the short term but also in the medium-long term.
免疫性血小板减少症（ITP）的治疗方法近来有所改变；然而，每种治疗方法都既有优点，也有缺点，并且可能会出现意想不到的并发症。我们描述了一例具有指导意义的ITP病例，该病例在接受口服血小板生成素受体激动剂（TPO-RA）药物艾曲泊帕加泼尼松龙（PSL）并同时进行脾切除术的治疗过程中并发了严重的门静脉血栓形成。一名男性ITP患者在我院接受艾曲泊帕治疗四年多后，于51岁时接受了脾切除术。脾切除术后不久，出现了脾静脉和门静脉血栓形成，而脾切除术无效。血栓消失后患者恢复了艾曲泊帕治疗。尽管观察到血小板计数（PLT）有波动，但艾曲泊帕和PSL仍联合使用了一段时间。随后，下肢深静脉血栓复发，给予甲苯磺酸艾多沙班共治疗8.4个月。脾切除术后三年多，患者54岁时，腹部计算机断层扫描（CT）显示有一个连续的血栓，从肝内门静脉延伸至肠系膜上静脉。对于脾切除术失败且需要继续使用TPO-RA±PSL进行治疗的ITP患者，临床医生不仅应在短期内，而且应在中长期通过CT成像随访，意识到发生腹部血栓形成不良事件的可能性，如严重的门静脉血栓形成。
