Immune thrombocytopenia associated with lymph node tuberculosis: a case report

Abstract

Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.

FIGURE 1:. Chest tomography with the affected lymph nodes marked.

FIGURE 2:. (A) Paraaortic lymph node biopsy, presenting gigantocellular reaction with foci of caseous necrosis associated with a lymphocytic inflammatory infiltrate. Hematoxylin-eosin, 40x magnification. (B) Left upper lobe biopsy of the lung, showing caseous necrosis, adjacent epithelioid histiocytes, organized alveolar pneumonia, alveolar septal/interstitial fibrosis, central acinar emphysema and alveolar exudate macrophages. Hematoxylin-eosin, 40x magnification.

FIGURE 3:. Graph showing platelet count per microliter at hospital admission and throughout treatment.