A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report
Abstract Background Immune thrombocytopenia is an acquired autoimmune disease. Recently, there has been evidence of thrombotic risk in patients with immune thrombocytopenia, but the mechanism is still inconclusive. Intravenous immunoglobulin infusion therapy is considered an efficient treatment; how...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-01-01
|
| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13256-018-1955-x |
| _version_ | 1818160484173479936 |
|---|---|
| author | Tarinee Rungjirajittranon Weerapat Owattanapanich |
| author_facet | Tarinee Rungjirajittranon Weerapat Owattanapanich |
| author_sort | Tarinee Rungjirajittranon |
| collection | DOAJ |
| description | Abstract Background Immune thrombocytopenia is an acquired autoimmune disease. Recently, there has been evidence of thrombotic risk in patients with immune thrombocytopenia, but the mechanism is still inconclusive. Intravenous immunoglobulin infusion therapy is considered an efficient treatment; however, it still is associated with adverse events of fever, chills, and hypotension, as well as serious complications such as thrombosis. We report a case a patient with relapsed immune thrombocytopenia who developed ischemic stroke after an intravenous immunoglobulin infusion. Case presentation A 49-year-old Thai woman with relapsed/refractory immune thrombocytopenia came to our hospital with a large hematoma at the right buttock, and her platelet was decreased to 3 × 109/L. She was admitted to our hospital for intravenous immunoglobulin administration. One hour after completion of intravenous immunoglobulin infusion, the patient’s sister complained that the patient was unconscious and could not move both legs and arms. Emergency computed tomography of the brain showed no abnormal findings, such as brain edema, intracranial hemorrhage, or infarction. One day later, repeat computed tomography of the brain displayed extensive acute ischemic changes and loss of gray-white differentiation of bilateral cerebral hemispheres. Conclusions We performed an extensive literature review to determine the possible causes of serious thrombotic events in immune thrombocytopenia between the predictive factors of the disease and intravenous immunoglobulin. Although intravenous immunoglobulin is an effective treatment, thrombotic complications can occur. We emphasize that in patients with atherosclerosis risk factors or thrombophilia, the appropriateness of administering an intravenous immunoglobulin infusion should be carefully evaluated. |
| first_indexed | 2024-12-11T16:02:36Z |
| format | Article |
| id | doaj.art-71bb592e83224d709400e3dd85d85b36 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-11T16:02:36Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-71bb592e83224d709400e3dd85d85b362022-12-22T00:59:17ZengBMCJournal of Medical Case Reports1752-19472019-01-011311610.1186/s13256-018-1955-xA serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case reportTarinee Rungjirajittranon0Weerapat Owattanapanich1Division of Medicine, Phranangklao HospitalDivision of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityAbstract Background Immune thrombocytopenia is an acquired autoimmune disease. Recently, there has been evidence of thrombotic risk in patients with immune thrombocytopenia, but the mechanism is still inconclusive. Intravenous immunoglobulin infusion therapy is considered an efficient treatment; however, it still is associated with adverse events of fever, chills, and hypotension, as well as serious complications such as thrombosis. We report a case a patient with relapsed immune thrombocytopenia who developed ischemic stroke after an intravenous immunoglobulin infusion. Case presentation A 49-year-old Thai woman with relapsed/refractory immune thrombocytopenia came to our hospital with a large hematoma at the right buttock, and her platelet was decreased to 3 × 109/L. She was admitted to our hospital for intravenous immunoglobulin administration. One hour after completion of intravenous immunoglobulin infusion, the patient’s sister complained that the patient was unconscious and could not move both legs and arms. Emergency computed tomography of the brain showed no abnormal findings, such as brain edema, intracranial hemorrhage, or infarction. One day later, repeat computed tomography of the brain displayed extensive acute ischemic changes and loss of gray-white differentiation of bilateral cerebral hemispheres. Conclusions We performed an extensive literature review to determine the possible causes of serious thrombotic events in immune thrombocytopenia between the predictive factors of the disease and intravenous immunoglobulin. Although intravenous immunoglobulin is an effective treatment, thrombotic complications can occur. We emphasize that in patients with atherosclerosis risk factors or thrombophilia, the appropriateness of administering an intravenous immunoglobulin infusion should be carefully evaluated.http://link.springer.com/article/10.1186/s13256-018-1955-xImmune thrombocytopeniaThrombosisStrokeIntravenous immunoglobulin |
| spellingShingle | Tarinee Rungjirajittranon Weerapat Owattanapanich A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report Journal of Medical Case Reports Immune thrombocytopenia Thrombosis Stroke Intravenous immunoglobulin |
| title | A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report |
| title_full | A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report |
| title_fullStr | A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report |
| title_full_unstemmed | A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report |
| title_short | A serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin: a case report |
| title_sort | serious thrombotic event in a patient with immune thrombocytopenia requiring intravenous immunoglobulin a case report |
| topic | Immune thrombocytopenia Thrombosis Stroke Intravenous immunoglobulin |
| url | http://link.springer.com/article/10.1186/s13256-018-1955-x |
| work_keys_str_mv | AT tarineerungjirajittranon aseriousthromboticeventinapatientwithimmunethrombocytopeniarequiringintravenousimmunoglobulinacasereport AT weerapatowattanapanich aseriousthromboticeventinapatientwithimmunethrombocytopeniarequiringintravenousimmunoglobulinacasereport AT tarineerungjirajittranon seriousthromboticeventinapatientwithimmunethrombocytopeniarequiringintravenousimmunoglobulinacasereport AT weerapatowattanapanich seriousthromboticeventinapatientwithimmunethrombocytopeniarequiringintravenousimmunoglobulinacasereport |