Rattaipalivalasu Saravanan Dhayananth, Pendyala Manogna, Kaur Purnoor, Jamal Raheel, Al-Nsour Mohammad
Internal Medicine, Mercy Health St. Vincent Medical Center, Toledo, USA.
Pulmonary and Critical Care Medicine, Mercy Health St. Vincent Medical Center, Toledo, USA.
Cureus. 2025 Jul 23;17(7):e88588. doi: 10.7759/cureus.88588. eCollection 2025 Jul.
We describe a rare case of a 64-year-old male who developed life-threatening thrombocytopenia two weeks after undergoing endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm. He presented with mucocutaneous bleeding manifestations, and laboratory findings revealed a critically low platelet count (<2 × 10/L). An extensive workup identified a positive stool antigen test and autoimmune markers, including antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. The close temporal relationship with EVAR initially raised concern for procedure-related complications, such as heparin-induced thrombocytopenia, although this was ultimately ruled out. Given the severity and refractoriness of thrombocytopenia to steroids alone, intravenous immunoglobulin (IVIG) was added. The patient's platelet counts improved following combined corticosteroid, IVIG, and eradication therapy. This unusual confluence of a recent vascular procedure, infectious, and autoimmune triggers highlights a rare and diagnostically challenging case of secondary immune thrombocytopenia (ITP), emphasizing the need for comprehensive evaluation and tailored management in similar clinical scenarios.
我们描述了一例罕见病例，一名64岁男性在接受腹主动脉瘤血管内修复术（EVAR）两周后出现危及生命的血小板减少症。他出现了黏膜皮肤出血表现，实验室检查结果显示血小板计数极低（<2×10/L）。全面检查发现粪便抗原检测呈阳性以及自身免疫标志物阳性，包括抗核抗体（ANA）和抗双链DNA（抗dsDNA）抗体。与EVAR在时间上的密切关联最初引发了对手术相关并发症的担忧，如肝素诱导的血小板减少症，尽管最终排除了这种情况。鉴于血小板减少症的严重程度以及单独使用类固醇治疗无效，加用了静脉注射免疫球蛋白（IVIG）。在联合使用皮质类固醇、IVIG和根除治疗后，患者的血小板计数有所改善。近期血管手术、感染和自身免疫触发因素的这种不寻常的共同作用凸显了一例罕见且诊断具有挑战性的继发性免疫性血小板减少症（ITP）病例，强调了在类似临床情况下进行全面评估和个性化管理的必要性。
