Tuberculosis presenting as immune thrombocytopenia
A 19-year-old male presented with chief complaints of generalised weakness and unintentional weight loss from 50 Kg to 45 Kg within a span of 1 month. He complained of fever for 15 days and had developed petechiae over bilateral upper limbs and bilateral subconjunctival haemorrhage. Laboratory inves...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Clinical and Scientific Research |
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| Online Access: | http://www.jcsr.co.in/article.asp?issn=2277-5706;year=2022;volume=11;issue=5;spage=58;epage=61;aulast=Moka |
| _version_ | 1818482856581660672 |
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| author | Deepak Moka Sai Subrahmanyam Pappu Rajender Badavath M Nageshwar Rao |
| author_facet | Deepak Moka Sai Subrahmanyam Pappu Rajender Badavath M Nageshwar Rao |
| author_sort | Deepak Moka |
| collection | DOAJ |
| description | A 19-year-old male presented with chief complaints of generalised weakness and unintentional weight loss from 50 Kg to 45 Kg within a span of 1 month. He complained of fever for 15 days and had developed petechiae over bilateral upper limbs and bilateral subconjunctival haemorrhage. Laboratory investigations done elsewhere showed platelet count of 10,000/mm3. On further investigation, Widal test, dengue serology, and smear examination for malarial parasite, antinuclear antibodies, and viral markers were negative. Abdominal ultrasonography showed multiple conglomerative enlarged lymph nodes in peripancreatic, peripatetic and paracaval, with few of them showing necrosis and loss of hilum and minimal ascites. Bone marrow examination showed megakaryocytic hyperplasia features, suggestive of immune thrombocytopenic purpura (ITP). No improvement in the platelet count was noted with intravenous methylprednisolone. On examination, the patient had ecchymotic patches over bilateral upper limbs and bilateral subconjunctival haemorrhages. Bilateral supraclavicular lymph nodes were palpable, non-tender, mobile, measuring 3 cm × 3 cm in the right side and 2 cm × 2 cm in the left side and firm in consistency. Cervical lymph node biopsy showed caseous necrotising granulomatous inflammation. Contrast-enhanced computed tomography neck, chest and abdomen showed multiple enlarged conglomerated heterogeneous enhancing lymph nodes with central non-enhancing areas s/o necrosis noted in the neck, mediastinum and abdomen. Tuberculin skin test (Mantoux test) revealed induration of 20 mm. The patient was started on eltrombopag, and four doses of intravenous immunoglobulin were given without improvement. The patient was started on liver-friendly anti-tuberculosis treatment in view of deranged liver function tests with isoniazid, rifampicin, ethambutol and levofloxacin and later pyrazinamide was added. The platelet count increased after 1 month of ATT to 40,000, and after 2 months, the count was 100,000/mm3. |
| first_indexed | 2024-12-10T11:52:14Z |
| format | Article |
| id | doaj.art-2e28021e74db4997b2fb0e8372445242 |
| institution | Directory Open Access Journal |
| issn | 2277-5706 2277-8357 |
| language | English |
| last_indexed | 2024-12-10T11:52:14Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Clinical and Scientific Research |
| spelling | doaj.art-2e28021e74db4997b2fb0e83724452422022-12-22T01:49:53ZengWolters Kluwer Medknow PublicationsJournal of Clinical and Scientific Research2277-57062277-83572022-01-01115586110.4103/jcsr.jcsr_71_21Tuberculosis presenting as immune thrombocytopeniaDeepak MokaSai Subrahmanyam PappuRajender BadavathM Nageshwar RaoA 19-year-old male presented with chief complaints of generalised weakness and unintentional weight loss from 50 Kg to 45 Kg within a span of 1 month. He complained of fever for 15 days and had developed petechiae over bilateral upper limbs and bilateral subconjunctival haemorrhage. Laboratory investigations done elsewhere showed platelet count of 10,000/mm3. On further investigation, Widal test, dengue serology, and smear examination for malarial parasite, antinuclear antibodies, and viral markers were negative. Abdominal ultrasonography showed multiple conglomerative enlarged lymph nodes in peripancreatic, peripatetic and paracaval, with few of them showing necrosis and loss of hilum and minimal ascites. Bone marrow examination showed megakaryocytic hyperplasia features, suggestive of immune thrombocytopenic purpura (ITP). No improvement in the platelet count was noted with intravenous methylprednisolone. On examination, the patient had ecchymotic patches over bilateral upper limbs and bilateral subconjunctival haemorrhages. Bilateral supraclavicular lymph nodes were palpable, non-tender, mobile, measuring 3 cm × 3 cm in the right side and 2 cm × 2 cm in the left side and firm in consistency. Cervical lymph node biopsy showed caseous necrotising granulomatous inflammation. Contrast-enhanced computed tomography neck, chest and abdomen showed multiple enlarged conglomerated heterogeneous enhancing lymph nodes with central non-enhancing areas s/o necrosis noted in the neck, mediastinum and abdomen. Tuberculin skin test (Mantoux test) revealed induration of 20 mm. The patient was started on eltrombopag, and four doses of intravenous immunoglobulin were given without improvement. The patient was started on liver-friendly anti-tuberculosis treatment in view of deranged liver function tests with isoniazid, rifampicin, ethambutol and levofloxacin and later pyrazinamide was added. The platelet count increased after 1 month of ATT to 40,000, and after 2 months, the count was 100,000/mm3.http://www.jcsr.co.in/article.asp?issn=2277-5706;year=2022;volume=11;issue=5;spage=58;epage=61;aulast=Mokaimmune thrombocytopenialymph nodestuberculosis |
| spellingShingle | Deepak Moka Sai Subrahmanyam Pappu Rajender Badavath M Nageshwar Rao Tuberculosis presenting as immune thrombocytopenia Journal of Clinical and Scientific Research immune thrombocytopenia lymph nodes tuberculosis |
| title | Tuberculosis presenting as immune thrombocytopenia |
| title_full | Tuberculosis presenting as immune thrombocytopenia |
| title_fullStr | Tuberculosis presenting as immune thrombocytopenia |
| title_full_unstemmed | Tuberculosis presenting as immune thrombocytopenia |
| title_short | Tuberculosis presenting as immune thrombocytopenia |
| title_sort | tuberculosis presenting as immune thrombocytopenia |
| topic | immune thrombocytopenia lymph nodes tuberculosis |
| url | http://www.jcsr.co.in/article.asp?issn=2277-5706;year=2022;volume=11;issue=5;spage=58;epage=61;aulast=Moka |
| work_keys_str_mv | AT deepakmoka tuberculosispresentingasimmunethrombocytopenia AT saisubrahmanyampappu tuberculosispresentingasimmunethrombocytopenia AT rajenderbadavath tuberculosispresentingasimmunethrombocytopenia AT mnageshwarrao tuberculosispresentingasimmunethrombocytopenia |