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Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after

Shuichi Okaya1, Hiroshi Ito1, Tomoya Shiba2

  • 1Department of Hospital Medicine, University of Tsukuba Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|March 4, 2026
PubMed

Severe thrombocytopenia is a frequent but diagnostically challenging complication in people living with human immunodeficiency virus (HIV) (PLWH). We report the case of a 43-year-old woman with HIV who developed life-threatening hematochezia and profound thrombocytopenia after the interruption of antiretroviral therapy. Although bone marrow aspiration showed hypocellular fatty marrow, preserved leukocyte counts and the overall clinical context supported immune thrombocytopenia (ITP) secondary to uncontrolled HIV replication. Treatment with intravenous immunoglobulin and high-dose corticosteroids led to independent transfusion and platelet recovery. Helicobacter pylori infection was identified and eradicated. This case highlights the fact that hypocellular marrow findings mimicking bone marrow failure do not exclude ITP in PLWH.

Keywords:
HIV-associated thrombocytopeniaaplastic anemiaimmune thrombocytopeniaplatelet transfusion refractorinesssevere bleeding

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