Korean J Gastroenterol.  2014 Oct;64(4):234-238. 10.4166/kjg.2014.64.4.234.

A Case of Immune Thrombocytopenic Purpura Accompanying Ulcerative Colitis

• Kim HT
• Kim TO
• Kim HJ
• Lee SI
• Jeon GJ
• Lee EJ
• Park S
• No T

• KMID: 1979209
• DOI: http://doi.org/10.4166/kjg.2014.64.4.234

Abstract

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of the colon with a variable clinical course of exacerbation and remission. Extraintestinal manifestations of UC, including hematological disorders, such as the rare immune thrombocytopenic purpura (ITP), may be the presenting symptoms. We encountered the case of a 23-year-old man with UC who showed typical symptoms and endoscopic findings. Despite receiving steroid treatment, the patient developed severe thrombocytopenia. He was diagnosed with ITP, characterized by autoimmunity, a demonstrated low platelet count, normal bone marrow, positivity for autoantibody to platelet membrane antigen, and no splenomegaly. We initiated high dose intravenous immunoglobulin immediately for treatment of his steroid-refractory thrombocytopenia. The patient's hematochezia and platelet count improved following immunoglobulin treatment. After discharge, the patient's platelet count was maintained at a stable level and his condition was good. This case suggests that immunoglobulin therapy may be useful for treatment of ITP in UC.

Keyword

Ulcerative colitis; Immune thrombocytopenic purpura; Immunoglobulin

MeSH Terms

Autoimmunity
Blood Platelets
Bone Marrow
Colitis, Ulcerative*
Colon
Gastrointestinal Hemorrhage
Humans
Immunization, Passive
Immunoglobulins
Membranes
Platelet Count
Purpura, Thrombocytopenic, Idiopathic*
Splenomegaly
Thrombocytopenia
Young Adult
Immunoglobulins

Figure

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  Fig. 1. Sigmoidoscopic findings. (A) Sigmoidoscopic findings in the sigmoid colon, is showing friable mucosa and shallow ulcers with exudate. (B) Sigmoidoscopic findings in the rectum, is showing edematous and ery-thematous mucosa.

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  Fig. 2. Abdominal computed tomography is showing diffuse bowel wall thickening, submucosal edema, and pericolic fat infiltration of the entire colorectum, sparing cecum, and no evidence of splenomegaly.

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  Fig. 3. Bone marrow biopsy finding is showing normocellularity with normal megakaryocytes (H&E, ×40).

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  Fig. 4. The course of platelet count and treatment in the ulcerative colitis. IV, intravenous; IVIG, intravenous immunoglobulin; TPN, total parenteral nutrition; PDL, prednisolone.

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  Fig. 5. Colonoscopic findings. (A) Colonoscopic findings in the sigmoid colon, is showing scarry changes of mucosa. (B) Colonoscopic findings in the rectum, is showing healing mucosa.

Reference

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