Kronik rekürren ITP ve Crohn Hastaligi birlikteligi olan bir olgu
The association of chronic recurrent immune thrombocytopenic purpura and crohn’s disease: A case report
Özet
beInflamatuvar barsak hastaligi ve immun trombositopenik purpura (ITP) birlikteligi çok nadir bildirilmistir. Kronik ITP tanisi alan ve izlemde Crohn hastaligi gelisen bir hasta sunuyoruz. Besbuçuk yasindaki erkek hasta bir yildir devam eden karin agrisi, günde 7-10 kez sulu, mukuslu diskilama, kendiliginden geçen artrit, kilo kaybi yakinmasi ile klinigimize basvurdu. Radyolojik, endoskopik ve histopatolojik bulgulari Crohn hastaligi ile uyumlu bulundu ve steroid ve mesalamin tedavisine baslandi. Bir yil sonra bacaklarda morarma nedeni ile ikinci kez yatirildi. Trombositopeni, kemik iliginde megakaryosit artisi ile ITP rekürrensi olarak degerlendirildi, metilprednizolon, IVIG, anti D globülin verildi. Medikal tedaviye dirençli ITP nedeni ile splenektomi planlandi. Hasta halen mesalamin tedavisi almaktadir ve ITP ataklarinin oldugu dönemde Crohn hastaligi kontrol altindadir. Inflamatuvar barsak hastaligi ile ITP patogenezinde immun disregülasyon rol oynamaktaysa da immunolojik hipotezler iki hastalik arasindaki iliskiyi açiklamada yetersiz kalmaktadi r. ITP’li hastalarda tekrarlayan ishal, artrit ve demir eksikligi anemisi, uzamis rektal kanamanin inflamatuvar barsak hastaligi açisindan uyarici olmasi gerektigini vurgulamak istedik.
Abstract
The association of immune thrombocytopenic purpura (ITP) and inflammatory bowel disease (IBD) is rarerly reported. Here we describe a case who was previously diagnosed as ITP and developed Crohn’s disease thereafter. A 5.5-year-old-boy was admitted to our hospital with a oneyear history of abdominal pain, watery diarrhea, weight loss and spontaneously recovered arthritis. He was diagnosed as Crohn’s disease based on radiological, endoscopical and histological findings and treatment was started with steroid and mesalamine.One year after his initial presentation, he was hospitalized again with purpura on his lower extremities. It was regarded as recurrent ITP with thrombocytopenia and increased megakaryocytes in bone marrow aspiration; splenectomy was planned due to refractory thrombocytopenia. Further studies are required to discover pathogenesis of this association. We emphasize that recurrent diarrhea, arthritis and iron deficiency anemia should raise suspicion of IBD in a patient with ITP.
