Immune Thrombocytopenic Purpura as an extra-intestinal manifestation in a patient with Ulcerative Colitis

Abstract

Immune thrombocytopenic purpura (ITP) is characterized by immune-mediated platelet destruction of platelets. The condition involves the presence of autoantibodies targeting platelet membrane antigens. ITP has been documented in the literature as a rare extra-intestinal manifestation of inflammatory bowel disease (IBD). This case report aims to describe the rare association of ITP as an extra-intestinal manifestation of ulcerative colitis (UC), accompanied by a literature review. We report the case of a 21-year-old male presenting with acute bloody diarrhea refractory to broad-spectrum antibiotic therapy. Given the patient’s significant history of intermittent persistent diarrhea, hematochezia, hematuria, and thrombocytopenia, an evaluation for relapsing IBD was undertaken. Colonoscopic biopsy findings were consistent, with UC showing mild activity, while bone marrow aspiration revealed features indicative of chronic ITP. The patient was managed with oral corticosteroids for the IBD flare and oral mesalamine, resulting in a significant improvement in platelet count. Upon follow-up, with remission of UC, it was accompanied by a complete normalization of the patient’s platelet count. ITP has been reported as a rare extra-intestinal manifestation of IBD (UC). This report emphasizes the importance of suspecting IBD in cases of unexplained thrombocytopenia, particularly in compatible clinical settings, to enable timely diagnosis and management of both conditions, ultimately improving patient outcomes.

Keywords

• Thrombocytopenia,
• Infammatory Bowel Disease
• Hematochezia

Ethical Statement

No Approval is required letter from the Institutional Ethical Committee of Government Medical College Srinagar, Kashmir, India vide Ref. No. IRBGMC-SGR/MED/860dated 21/11/2024

References

1. Ford AC, Moayyedi P, Hanauer SB. Ulcerative colitis. BMJ. 2013 Feb 5;346:f432. doi: 10.1136/bmj.f432.
2. Harbord M, Annese V, Vavricka SR, Allez M, Barreiro-de Acosta M, Boberg KM, Burisch J, De Vos M, De Vries AM, Dick AD, Juillerat P, Karlsen TH, Koutroubakis I, Lakatos PL, Orchard T, Papay P, Raine T, Reinshagen M, Thaci D, Tilg H, Carbonnel F; European Crohn’s and Colitis Organisation. The first european evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016 Mar;10(3):239-54. doi: 10.1093/ecco-jcc/jjv213.
3. Queliza K, Ihekweazu FD, Ali A, Kellermayer R. Inflammatory bowel disease and immune thrombocytopenic purpura: Combined immune dysregulation in an adolescent. Ann Clin Lab Sci. 2017 Mar;47(2):226-8.
4. Epistola R, Do T, Vankina R, Wu D, Yeh J, Fleischman MW, Lee JM. Immune thrombocytopenic purpura (ITP) as an uncommon extraintestinal complication of Crohn’s disease: Case vignette and systematic literature review. Case Rep Hematol. 2020 Mar 26;2020:4785759. doi: 10.1155/2020/4785759.
5. Chandra S, Finn S, Obah E. Immune thrombocytopenic purpura in ulcerative colitis: a case report and systematic review. J Community Hosp Intern Med Perspect. 2014 Apr 14;4(2). doi: 10.3402/jchimp.v4.23386.
6. Cohen R, Robinson D Jr, Paramore C, Fraeman K, Renahan K, Bala M. Autoimmune disease concomitance among inflammatory bowel disease patients in the United States, 2001-2002. Inflamm Bowel Dis. 2008 Jun;14(6):738-43. doi: 10.1002/ibd.20406.
7. Halling ML, Kjeldsen J, Knudsen T, Nielsen J, Hansen LK. Patients with inflammatory bowel disease have increased risk of autoimmune and inflammatory diseases. World J Gastroenterol. 2017 Sep 7;23(33):6137-6146. doi: 10.3748/wjg.v23.i33.6137.
8. Iwasa T, Nakamura K, Ihara E, Aso A, Ito T. The effective treatment with cyclosporine of a ulcerative colitis patient with concurrent idiopathic thrombocytopenic purpura who subsequently developed spontaneous pneumomediastinum. Intern Med. 2017;56(11):1331-1337. doi: 10.2169/internalmedicine.56.7909.

9. Brunet E, Martínez de Sola M, Garcia-Iglesias P, Calvet X. Immune thrombocytopenic purpura associated with Crohn’s disease with complete response to infliximab. Gastroenterol Hepatol. 2019 Jan;42(1):37-8. doi: 10.1016/j.gastrohep.2018.01.011.
10. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, Burisch J, Gecse KB, Hart AL, Hindryckx P, Langner C, Limdi JK, Pellino G, Zagórowicz E, Raine T, Harbord M, Rieder F; European Crohn’s and Colitis Organisation [ECCO]. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017 Jun 1;11(6):649-70. doi: 10.1093/ecco-jcc/jjx008.