Korean J Med.  2014 Mar;86(3):362-366. 10.3904/kjm.2014.86.3.362.

A Case of Immune Thrombocytopenic Purpura Associated with Scrub Typhus

• Kim HA
• Lee JY
• Hyun M
• Ryu SY

• KMID: 1867371
• DOI: http://doi.org/10.3904/kjm.2014.86.3.362

Abstract

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered.

Keyword

Scrub typhus; Autoimmune thrombocytopenia; Gastrointestinal hemorrhage

MeSH Terms

Antibodies
Blood Platelets
Bone Marrow
Disseminated Intravascular Coagulation
Facial Paralysis
Gastrointestinal Hemorrhage
Guillain-Barre Syndrome
Humans
Hypersplenism
Korea
Leg
Purpura
Purpura, Thrombocytopenic, Idiopathic*
Scrub Typhus*
Thrombocytopenia
Antibodies