Thrombocytopenia in HIV patients coinfected with tuberculosis

Thrombocytopenia is one of the most common hematological manifestations seen in HIV patients with approximately 40% of the patients developing thrombocytopenia during their course of illness. Opportunistic infection like tuberculosis is a rare but curative cause of thrombocytopenia in these patients. Clinically, it is a challenge to determine the exact cause and decide the treatment of thrombocytopenia in these patients as both infections can lead to significant thrombocytopenia by varied mechanisms. The treatment options are limited by drug antitubercular treatment highly active antiretroviral therapy (ATT and HAART)-induced thrombocytopenia. A 25-year-old male patient presented with low grade, intermittent fever with left-sided pleuritic chest pain for 2 months along with dry cough, weight loss, malaise, and lethargy. Hematological examination showed anemia, leukopenia, and thrombocytopenia. The patient was found to be HIV reactive. Chest X-ray revealed nonhomogenous opacity with cavitation in the left upper and middle zone suggestive of tuberculosis. He received multiple units of blood and platelets and was started on isoniazid, rifampicin, pyrazinamide, and ethambutol. HAART was initiated 2 weeks after starting ATT. Patient's hematological parameters improved and he was discharged on ATT and HAART with recovery of the platelet counts. Thrombocytopenia is a complication associated with both HIV and tuberculosis and hence determining the cause and deciding the appropriate treatment is challenging. Decision about whom and when to treat has to be taken cautiously considering all possible contributors and treatment has to be individualized.