Abstract
Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of the colon with a variable clinical course of exacerbation and remission. Extraintestinal manifestations of UC, including hematological disorders, such as the rare immune thrombocytopenic purpura (ITP), may be the presenting symptoms. We encountered the case of a 23-year-old man with UC who showed typical symptoms and endoscopic findings. Despite receiving steroid treatment, the patient developed severe thrombocytopenia. He was diagnosed with ITP, characterized by autoimmunity, a demonstrated low platelet count, normal bone marrow, positivity for autoantibody to platelet membrane antigen, and no splenomegaly. We initiated high dose intravenous immunoglobulin immediately for treatment of his steroid-refractory thrombocytopenia. The patient's hematochezia and platelet count improved following immunoglobulin treatment. After discharge, the patient's platelet count was maintained at a stable level and his condition was good. This case suggests that immunoglobulin therapy may be useful for treatment of ITP in UC.
References
1. Greenstein AJ, Janowitz HD, Sachar DB. The extraintestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore). 1976; 55:401–412.
2. Gernsheimer T. Chronic idiopathic thrombocytopenic purpura: mechanisms of pathogenesis. Oncologist. 2009; 14:12–21.
3. Mares WG, Gerver J, Masclee AA, Pierik M. Anti-TNF treatment of ulcerative colitis associated with idiopathic thrombocytopenic purpura. Inflamm Bowel Dis. 2011; 17:864–865.
4. Mizuta Y, Isomoto H, Kadokawa Y, et al. Immune thrombocytopenic purpura in patients with ulcerative colitis. J Gastroenterol. 2003; 38:884–890.
5. Kwon JH, Lee C, Choi JM, et al. A case of immune thrombocytopenic purpura associated with preexisting ulcerative colitis treated with colectomy and splenectomy. Intest Res. 2013; 11:310–316.
6. Zlatanic J, Korelitz BI, Wisch N, et al. Inflammatory bowel disease and immune thrombocytopenic purpura: is there a correlation? Am J Gastroenterol. 1997; 92:2285–2288.
7. Yoshida EM, Chaun H, Freeman HJ, Whittaker JS, Galbraith PF. Immune thrombocytopenic purpura in three patients with preexisting ulcerative colitis. Am J Gastroenterol. 1996; 91:1232–1235.
8. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115:168–186.
9. Hershko C, Ianculovich M, Souroujon M. A hematologist's view of unexplained iron deficiency anemia in males: impact of Helicobacter pylori eradication. Blood Cells Mol Dis. 2007; 38:45–53.
10. Annibale B, Lahner E, Bordi C, et al. Role of Helicobacter pylori infection in pernicious anaemia. Dig Liver Dis. 2000; 32:756–762.
11. Gasbarrini A, Franceschi F, Tartaglione R, Landolfi R, Pola P, Gasbarrini G. Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori. Lancet. 1998; 352:878.
12. Edwards FC, Truelove SC. Course and prognosis of ulcerative colitis: part III complications. Gut. 1964; 5:1–15.
14. Nonami Y, Yamashiro T, Yamamoto A, et al. Double lung cancer combined with idiopathic thrombocytopenic purpura. A case report. J Cardiovasc Surg (Torino). 1999; 40:889–892.
15. den Ottolander GJ, Gratama JW, de Koning J, Brand A. Long-term follow-up study of 168 patients with immune thrombocytopenia. Implications for therapy. Scand J Haematol. 1984; 32:101–110.
16. DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Adult idiopathic thrombocytopenic purpura. Clinical findings and response to therapy. Am J Med. 1980; 69:430–442.
17. Clarkson SB, Bussel JB, Kimberly RP, Valinsky JE, Nachman RL, Unkeless JC. Treatment of refractory immune thrombocytopenic purpura with an anti-Fc gamma-receptor antibody. N Engl J Med. 1986; 314:1236–1239.
18. Bussel JB, Pham LC. Intravenous treatment with gammaglobu-lin in adults with immune thrombocytopenic purpura: review of the literature. Vox Sang. 1987; 52:206–211.
19. Nam SW, Yang SK, Kim JC, et al. Immune thrombocytopenic pur-pur and neutropenia associatedwith ulcerative colitis. Korean J Gastroenterol. 1999; 33:135–141.