A rare case of patient with severe thrombocytopenia associated with sarcoidosis: a case study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20231358Keywords:
Sarcoidosis, Severe thrombocytopenia, Thrombocytopenia, Amoxicillin induced thrombocytopenia, Drug-induced thrombocytopenia, Case-studyAbstract
Thrombocytopenia is a problem causing drop in platelet counts through different mechanisms. Patients typically present with petechiae to systemic bleeding, which are indications of a low platelet count. A smaller percentage of drop may be asymptomatic. The major mechanisms include increased sequestration in the spleen, underproduction from the bone marrow, and peripheral destruction. Many etiological factors can cause this. Sarcoidosis is one of the most uncommon etiologies. A careful diagnosis is required because, if the condition is not treated, it can be fatal. Steroid therapy and platelet transfusions remain the mainstay of treatment. Here, we describe a patient who presented with signs and symptoms of severe thrombocytopenia, which further led to the diagnosis of sarcoidosis. An adult male presented to the emergency department with a rash that deteriorated throughout the day. Based on complaints and laboratory testing, severe thrombocytopenia was noted. After a detailed examination and history-taking, he was found to have sarcoidosis. In association with drug administration and sarcoidosis, this could have caused severe thrombocytopenia. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Thrombocytopenia is a disorder where platelet counts drop below 150×109/l due to many different mechanisms. Among different etiological factors, sarcoidosis is the rarest and may present with very severe thrombocytopenia and lead to fatal complications. Such patients require close monitoring and treatment. Corticosteroids and platelet transfusions can be used as treatments. In the presented case, the patient was successfully treated, and on subsequent follow-up, the patient’s condition improved. Manifestations of severe thrombocytopenia can be present even before the diagnosis of sarcoidosis. Further, the history of amoxicillin administration due to infection could have triggered the appearance of thrombocytopenia. Confirmation of sarcoidosis was made via biopsy. Multiple etiological factors that resulted in diagnostic ambiguity in our patient's presentation include the diagnosis of sarcoidosis, a history of infection, amoxicillin, and mild splenomegaly. The patient's treatment and recovery may indicate that corticosteroids, in conjunction with platelet transfusions, are beneficial. This is a novel case report of the presentation of severe thrombocytopenia, which was present even before the diagnosis of sarcoidosis.
References
Stasi R, Amadori S, Osborn J, Newland AC, Provan D. Long-Term Outcome of Otherwise Healthy Individuals with Incidentally Discovered Borderline Thrombocytopenia. PLoS Med. 2006;3:e24.
Diz-Küçükkaya R, López JA. Thrombocytopenia. In Williams Hematology. McGraw-Hill Education. 2015.
Stasi R. How to approach thrombocytopenia. Hematology. 2012;191-7.
Lee EJ, Lee AI. Thrombocytopenia. Primary Care: Clinics in Office Practice. 2016;43:543-57.
Moss RA. Drug-induced immune thrombocytopenia. Am J Hematol. 1980;9:439-46.
Dąbrowska M, Krenke R, Maskey-Warzęchowska M, Boguradzki P, Waszczuk-Gajda A, Jędrzejczak WW, et al. Primary immune thrombocytopenia in a patient with sarcoidosis. Pneumonol Alergol Pol. 2011;79(5):371-6.
Fordice J, Katras T, Jackson RE, Cagle PT, Jackson D, Zaleski H, et al. Massive splenomegaly in sarcoidosis. South Med J. 1992;85(7):775-8.
Mahévas M, Le Page L, Salle V, Lescure FX, Smail A, Cevallos R, et al. Thrombocytopenia in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2006;23(3):229-35.
Judson MA, Baughman RP, Teirstein AS, Terrin ML, Yeager H Jr. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 1999;16(1):75-86.
Korogodina A, Kaur N, Kumthekar A. Sarcoidosis-Associated Immune Thrombocytopenic Purpura and Focal Segmental Glomerulosclerosis. J Investig Med High Impact Case Rep. 2022;10:23247096221097522.
Medhat BM, Behiry ME, Fateen M, El-Ghobashy N, Fouda R, Embaby A, et al. Sarcoidosis beyond pulmonary involvement: A case series of unusual presentations. Respir Med Case Rep. 2021;34:101495.
Yanardağ H, Pamuk GE, Karayel T, Demirci S. Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples. Haematologia (Budap). 2002;32(4):419-25.
Mahévas M, Chiche L, Uzunhan Y, Khellaf M, Morin AS, Le Guenno G, et al. Association of sarcoidosis and immune thrombocytopenia: presentation and outcome in a series of 20 patients. Medicine (Baltimore). 2011;90(4):269-78.
George JN, Aster RH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. Hematology Am Soc Hematol Educ Program. 2009;153-8.
Starshinova AA, Malkova MM, Basantsova NY, Zinchenko YS, Kudryavtsev YV, Ershov GA, et al. Sarcoidosis as an Autoimmune Disease. Front Immunol. 2020;10.
