Vol 12, No 1 (2021)
Case report
Published online: 2021-09-29
Secondary immune thrombocytopenia after Streptococcus infection
1, 1
, 2, 1
, 2, 1
Hematology in Clinical Practice 2021;12(1):29-32.
Abstract
Immune thrombocytopenia is typically characterized by a decrease in platelet (PLT) count and bleeding diathesis symptoms or increased bleeding risk. In the report, we describe a case of a 19-year-old female patient who suffered from secondary immune thrombocytopenia in the course of streptococcal pharyngitis. After diagnosis, the patient received pharmacotherapy for thrombocytopenia according to Polish standards (intravenous dexamethasone sodium phosphate) which improved the platelet level. However, the change from dexamethasone intravenous to oral prednisone resulted in PLT level decrease. Hematological improvement was observed only after changing prednisone to methylprednisolone.
Keywords: immune thrombocytopeniastreptococcal pharyngitisdexamethasoneprednisonemethylprednisolone
References
- Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019; 381(10): 945–955.
- Audia S, Mahévas M, Samson M, et al. Pathogenesis of immune thrombocytopenia. Autoimmun Rev. 2017; 16(6): 620–632.
- Fountain EM, Arepally GM. Etiology and complications of thrombocytopenia in hospitalized medical patients. J Thromb Thrombolysis. 2017; 43(4): 429–436.
- Samson M, Fraser W, Lebowitz D. Treatments for primary immune thrombocytopenia: a review. Cureus. 2019; 11(10): e5849.
- Stasi R. Therapeutic strategies for hepatitis- and other infection-related immune thrombocytopenias. Semin Hematol. 2009; 46(1 Suppl 2): S15–S25.
- Hill LJN, Tung EE. From prednisone to pylori: a case of Helicobacter pylori-induced chronic immune thrombocytopenia. BMJ Case Rep. 2014; 2014.
- Kaplan BS, Esseltine D. Thrombocytopenia in patients with acute post-streptococcal glomerulonephritis. J Pediatr. 1978; 93(6): 974–976.
- Rizkallah MF, Ghandour MH, Sabbah R, et al. Acute thrombocytopenic purpura and poststreptococcal acute glomerulonephritis in a child. Clin Pediatr (Phila). 1984; 23(10): 581–583.
- Morrin MJ, Jones FGC, McConville J, et al. Thrombotic thrombocytopenic purpura secondary to Streptococcus. Transfus Apher Sci. 2006; 34(2): 153–155.
- Takahashi T, Yujiri T, Shinohara K, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004; 124(1): 91–96.
- Franceschi F, Christodoulides N, Kroll MH, et al. Helicobacter pylori and idiopathic thrombocytopenic purpura. Ann Intern Med. 2004; 140(9): 766–767.
- Semple JW, Aslam R, Kim M, et al. Platelet-bound lipopolysaccharide enhances Fc receptor-mediated phagocytosis of IgG-opsonized platelets. Blood. 2007; 109(11): 4803–4805.
- Byrne MF, Kerrigan SW, Corcoran PA, et al. Helicobacter pylori binds von Willebrand factor and interacts with GPIb to induce platelet aggregation. Gastroenterology. 2003; 124(7): 1846–1854.
- Plummer C, Wu H, Kerrigan SW, et al. A serine-rich glycoprotein of Streptococcus sanguis mediates adhesion to platelets via GPIb. Br J Haematol. 2005; 129(1): 101–109.
- Keane C, Petersen H, Reynolds K, et al. Mechanism of outside-in {alpha}IIb{beta}3-mediated activation of human platelets by the colonizing Bacterium, Streptococcus gordonii. Arterioscler Thromb Vasc Biol. 2010; 30(12): 2408–2415.
- Keane C, Petersen HJ, Tilley D, et al. Multiple sites on Streptococcus gordonii surface protein PadA bind to platelet GPIIbIIIa. Thromb Haemost. 2013; 110(6): 1278–1287.
- Wolff M, Handtke S, Palankar R, et al. Activated platelets kill Staphylococcus aureus, but not Streptococcus pneumoniae-The role of FcγRIIa and platelet factor 4/heparinantibodies. J Thromb Haemost. 2020; 18(6): 1459–1468.
- Zhang X, Gu S, You L, et al. Gut microbiome and metabolome were altered and strongly associated with platelet count in adult patients with primary immune thrombocytopenia. Front Microbiol. 2020; 11: 1550.
- Prednisone. https://www.drugbank.ca/drugs/DB00635 (September 23, 2020).
- Zanger UM, Schwab M. Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol Ther. 2013; 138(1): 103–141.
