J Rheum Dis.  2015 Feb;22(1):51-55. 10.4078/jrd.2015.22.1.51.

A Case of Essential Thrombocythemia in a Patient with Ankylosing Spondylitis Concomitantly Treated with Adalimumab

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. sglee@pnuh.co.kr
  • 2Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

Abstract

Extreme thrombocytosis in patients with ankylosing spondylitis (AS) is rarely reported. Because the relationship between high disease activity and increased platelet counts is somewhat contradictory, severe thrombocytosis in AS patients can be secondary to infection, iron deficiency anemia, drug administration, and hematologic malignancies. Essential thrombocythemia (ET) is a rare acquired stem cell neoplasm characterized by overproduction of platelets by megakaryocytes in the bone marrow in the absence of other causes of thrombocytosis. There is no report in the literature regarding the association between AS and ET. We report on a case of a 34-year-old Korean man with active AS diagnosed as JAK2V617F mutation negative ET during adalimumab treatment.

Keyword

Ankylosing spondylitis; Essential thrombocythemia; Tumor necrosis factor alpha

MeSH Terms

Adult
Anemia, Iron-Deficiency
Bone Marrow
Hematologic Neoplasms
Humans
Megakaryocytes
Platelet Count
Spondylitis, Ankylosing*
Stem Cells
Thrombocythemia, Essential*
Thrombocytosis
Tumor Necrosis Factor-alpha
Adalimumab
Tumor Necrosis Factor-alpha

Figure

  • Figure 1. Clinical course of the patient's platelet (PLT) count and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). BM: bone marrow.

  • Figure 2. Bone marrow biopsy in the patient shows hypercellular marrow (cellularity: 70%) with increased numbers of megakaryocytes with nuclear atypia such as hypolobulation (arrow in A), multinucleation (arrowhead in A) and grouping (cells <5, arrows in B) (H&E, ×400).


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