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[Cyclic thrombocytopenia with chronic thyroiditis and ankylosing spondylitis]
K Uozumi1, T Makino, S Shimotakahara
1Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University.
[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|September 1, 1992
Summary
A patient with cyclic thrombocytopenia and autoimmune conditions found that low-dose methotrexate effectively stabilized platelet counts. This case offers insights into the mechanisms behind cyclic thrombocytopenia.
Area of Science:
- Hematology
- Immunology
- Endocrinology
Background:
- Presents a case of a 58-year-old male initially diagnosed with idiopathic thrombocytopenic purpura (ITP).
- The patient also had co-existing chronic thyroiditis and ankylosing spondylitis, indicated by positive thyroid antibody tests and a "bamboo spine" radiographic finding with positive HLA B27.
Observation:
- Initial treatments for ITP, including corticosteroids, IVIg, danazol, vinca alkaloids, and splenectomy, provided only transient efficacy.
- Platelet counts fluctuated significantly (0.4 X 10(10)/L to 34.4 X 10(10)/L), leading to a revised diagnosis of cyclic thrombocytopenia.
Findings:
- Subnormal T3 and T4 levels with markedly elevated TSH indicated hypothyroidism.
- Low-dose methotrexate (MTX) therapy resulted in the resolution of cyclic platelet fluctuations, achieving stable platelet counts.
Implications:
- Suggests a potential link between autoimmune disorders and cyclic thrombocytopenia.
- Highlights low-dose methotrexate as a potential therapeutic option for managing cyclic thrombocytopenia, particularly in patients with co-existing autoimmune conditions.