Immune thrombocytopenia and its association with lymph node tuberculosis – A dilemma!

Abstract

Background: Although various hematologic abnormalities are known to occur with tuberculosis, association of immune mediated thrombocytopenia with tuberculosis is uncommon. Newly diagnosed immune thrombocytopenia in TB is rare; only 27 cases have been reported so far. Case: We report a case of axillary lymph node tuberculosis who presented with immune thrombocytopenia. An eighteen year old girl was admitted to our hospital with excessive vaginal bleed of one week duration followed by the development of petechial lesions and ecchymosis over legs, hands and mouth. She also had solitary, firm, left axillary lymphadenopathy. A diagnosis of immune mediated thrombocytopenia (ITP) was made from peripheral blood smear and bone marrow examination. Intravenous methylprednisolone (30mg/kg body weight) followed by oral prednisolone (1mg/kg) failed to elicit any sustained platelet response. Fine needle aspiration cytology of the left axillary lymphadenopathy done later revealed tuberculosis. After two weeks of starting anti-tuberculous therapy, the platelet count returned to normal and she was off all therapy for ITP thereby suggesting likely association between tuberculosis and immune thrombocytopenia. Conclusion: This case report illustrates the causal association between immune thrombocytopenia and tuberculosis.