Park Changsu L, Margaria Bryan, Husnain Muhammad
Department of Medicine, MetroHealth Medical Center, Cleveland, USA.
Cureus. 2022 Mar 27;14(3):e23551. doi: 10.7759/cureus.23551. eCollection 2022 Mar.
Immune thrombocytopenia (ITP) is a leading cause of isolated thrombocytopenia characterized by autoantibody-mediated destruction of platelets, impaired megakaryocyte function, and pathologic T-cell recognition of platelet antigens. Several triggers for ITP have been identified. Treatment of the inciting cause decreases the antibodies responsible for molecular mimicry, and these cases are usually associated with a better outcome with a decreased probability of progression to chronic ITP. infection is known to have extrapulmonary manifestations, and growing evidence suggests it can be a cause of secondary ITP. Many of the described cases report evidence of a pulmonary infection with severe mucosal bleeding. Here, we describe an interesting case of a patient presenting with isolated thrombocytopenia with mild mucosal bleeding, later found to be positive for immunoglobulin M without clinically significant evidence of active infection. Currently, mycoplasma testing is not routinely performed as a workup for ITP. However, clinicians may consider this before proceeding with more aggressive treatment for refractory ITP (i.e., prolonged immunosuppression, splenectomy). This case illustrates that mild/asymptomatic infection can also be associated with ITP.
免疫性血小板减少症（ITP）是孤立性血小板减少症的主要原因，其特征为自身抗体介导的血小板破坏、巨核细胞功能受损以及病理性T细胞对血小板抗原的识别。已确定ITP的几种触发因素。治疗诱发原因可减少负责分子模拟的抗体，这些病例通常预后较好，进展为慢性ITP的可能性降低。已知感染有肺外表现，越来越多的证据表明它可能是继发性ITP的一个原因。许多已描述的病例报告了肺部感染伴严重黏膜出血的证据。在此，我们描述了一例有趣的病例，一名患者出现孤立性血小板减少症并伴有轻度黏膜出血，后来发现免疫球蛋白M呈阳性，但无临床显著的活动性感染证据。目前，支原体检测并非ITP检查的常规项目。然而，临床医生在对难治性ITP进行更积极的治疗（即长期免疫抑制、脾切除术）之前可能会考虑此项检测。该病例表明轻度/无症状感染也可能与ITP有关。
