Thrombocytopenic Purpura Associated with Miliary Tuber
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SURAT TONGYOO, MD*, WARAKARN VILAICHONE, MD*,
SANYA SUKPANICHNANT,MD**, CHIRAYU AUEWARAKUL,MD***,
ANGKANA CHAIPRASERT, Dr rer nat****, RANIS TNA RAT ANARA T, MD*,
CHAIRAT PERMPIKUL, MD*
Affiliation : * Intensive Care Unit, Division of Critical Care, Department of Medicine,
** Department of Pathology,
*** Division of Hematology, Department of Medicine,
**** Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
t Presented as interesting case discussion at an inter-hospital conference of critical care in August, 2002
AbstractThe authors report a case of thrombocytopenia associated with miliary tuberculosis. The patient
was a 28-year-old woman who was admitted because of massive upper gastrointestinal hemorrhage
and acute respiratory failure. Chest radiographs revealed diffuse bilateral reticulonodular infiltration
and complete blood count was significant for severe thrombocytopenia. Bone marrow biopsy was
performed to investigate the cause of thrombocytopenia and demonstrated multiple tiny caseating
granulomas suggesting miliary tuberculosis (TB). She received anti-TB therapy and a short course of
steroid with good response. Platelet count returned to normal limit within 10 days. Although isolated
thrombocytopenia is uncommon in TB, it is still important to consider TB in the differential Jiagnosis
of thrombocytopenia, particularly in patients with abnormal chest radiographs. Bone marrow examina
tion is very helpful in this situation.
Keywords : Miliary Tuberculosis, Thrombocytopenia, Hemorrhage
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