Singh Jitendra, Dinkar Anju, Kumar Nilesh, Kumar Kailash, Ranjan Ravi, Atam Isha
Department of General Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Cardiovasc Hematol Disord Drug Targets. 2025 Aug 11. doi: 10.2174/011871529X388139250801045459.
Immune thrombocytopenia (ITP) is an autoimmune condition characterized by reduced platelet counts due to increased peripheral destruction and impaired platelet generation. An estimated incidence of ITP is 2 to 5 cases per 100,000 individuals in the general population. While mucocutaneous bleeding is common, life-threatening complications, such as spontaneous lingual hematoma and intracerebral hemorrhage (ICH), are extremely rare. Rapid progression of lingual haematomas might compromise airway function and necessitate immediate medical intervention. It is well established that most patients with ITP respond to first-line therapy; however, severe bleeding events, such as intracerebral hemorrhage, occur in less than 1% of cases and are associated with significant morbidity and mortality.
A 21-year-old male with a 6-month history of chronic ITP and poor compliance with therapy presented with a 2-day history of progressive reddish discoloration and swelling of the tongue. The clinical examination revealed stable vital signs and a remarkable general and systemic evaluation. The relevant blood routine showed a critically low platelet count at 8×103/μL, with normal coagulation parameters. No other bleeding manifestations were noted. Four hours after admission, the patient developed generalized tonic-clonic seizures and altered sensorium. Computed tomography (CT) of the head revealed an ICH. He was managed with single- donor platelet transfusions, intravenous anti-epileptics, pulse corticosteroid therapy, eltrombopag, and supportive care. The patient demonstrated a favorable clinical response, characterized by a rising platelet count and resolution of symptoms. He was discharged in stable condition with counseling on therapy adherence.
The present case emphasizes the rarely yet life-threatening complication of inadequately managed ITP, such as spontaneous lingual hematoma and intracranial haemorrhage. It highlights the vital significance of therapy adherence and timely interdisciplinary intervention to avert disastrous consequences. Timely detection and intervention are crucial for positive outcomes in these intricate cases.
免疫性血小板减少症（ITP）是一种自身免疫性疾病，其特征是由于外周破坏增加和血小板生成受损导致血小板计数减少。一般人群中ITP的估计发病率为每10万人中有2至5例。虽然黏膜皮肤出血很常见，但危及生命的并发症，如自发性舌血肿和脑出血（ICH）极为罕见。舌血肿的快速进展可能会损害气道功能，需要立即进行医疗干预。众所周知，大多数ITP患者对一线治疗有反应；然而，脑出血等严重出血事件发生在不到1%的病例中，且与显著的发病率和死亡率相关。
一名21岁男性，有6个月慢性ITP病史且治疗依从性差，出现舌部进行性发红变色和肿胀2天。临床检查显示生命体征稳定，全面系统评估无异常。相关血常规显示血小板计数极低，为8×10³/μL，凝血参数正常。未发现其他出血表现。入院4小时后，患者出现全身强直阵挛性癫痫发作，意识改变。头部计算机断层扫描（CT）显示脑出血。对其进行了单供体血小板输注、静脉注射抗癫痫药物、脉冲皮质类固醇治疗、艾曲泊帕以及支持治疗。患者表现出良好的临床反应，表现为血小板计数上升和症状缓解。他出院时情况稳定，并接受了关于坚持治疗的咨询。
本病例强调了ITP管理不当罕见但危及生命的并发症，如自发性舌血肿和颅内出血。它突出了坚持治疗和及时进行多学科干预以避免灾难性后果的至关重要性。在这些复杂病例中，及时检测和干预对于取得积极结果至关重要。
