Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc
Journal website https://www.thejh.org

Case Report

Volume 10, Number 2, April 2021, pages 71-75

Severe Cystic Echinococcosis-Associated Immune Thrombocytopenic Purpura: A Case Report

Figures

Figure 1.
Figure 1. Platelet levels since diagnosis. Diagnosis was made at day 0. Albendazole was started at 3 months (blue line). The peak in platelet count at 5 months coincided with surgery (red line) and its associated inflammatory response. There was a period of loss to follow-up between 7 and 21 months after diagnosis. At 21 months, our patient had its first and only relapse.
Figure 2.
Figure 2. Coronal images of the computed tomodensitometry scan performed at presentation. (a) Anterior cut demonstrating the large left lobe cystic lesion extending downwards towards the proximal transverse colon. (b) Middle view of the abdomen demonstrating the same lesion. (c) Posterior view of the abdomen demonstrating the posterior liver lesion.
Figure 3.
Figure 3. Postoperative partial hepatectomy specimen containing the large inferior left lobe hepatic cyst that was extending anteriorly into the abdominal fat and the proximal transverse colon. (a, b) View of the intact postoperative hepatic cyst and compared to a 15 cm (6 inches) ruler. (c, d) View of the inside of the large cyst following an excision of the cyst wall unveiling a multitude of intact smaller cysts of variable size containing a translucent fluid.

Tables

Table 1. Blood Work at Presentation
 
HIV: human immunodeficiency virus; COI: cut-off index.
White blood cells4.8 × 109/L
Hemoglobin126 g/L
Platelets5 × 109/L
Ferritin109 µg/L
HIV antibody/antigen0.22 COI (non-reactive)
Hepatitis B surface antibody901.900 IU/L (reactive)
Hepatitis B core antibody0.262 COI (reactive)
Hepatitis B surface antigen0.36 COI (non-reactive)
Hepatitis C antibody0.08 COI (non-reactive)
Creatinine66 µmol/L
Lactate dehydrogenase268 U/L
Haptoglobin1.73 g/L
Bilirubin15 µmol/L
Alanine aminotransferase29 U/L
Alkaline phosphatase96 U/L
Prothrombin time12.1 s
Activated partial thromboplastin time25.3 s
C-reactive protein13.7 mg/L

 

Table 2. Causes of Secondary Immune Thrombocytopenic Purpura
 
MMR: measles-mumps-rubella.
Viruses and bacteria
  Human immunodeficiency virus
  Hepatitis B virus
  Hepatitis C virus
  Cytomegalovirus
  Varicella-zoster virus
  Epstein-Barr virus
  Helicobacter pylori
Auto-immune disease
  Systemic lupus erythematosus
  Antiphospholipid syndrome
  Evan’s syndrome
  Rheumatoid arthritis
  Inflammatory bowel disease
Medication
  Pembrolizumab
  Nivolumab
  Alemtuzumab
Hematological etiology
  Chronic lymphocytic leukemia
  Lymphoproliferative disorders
  Side effect of bone marrow transplantation
Other
  Vaccines (i.e., MMR)
  Common variable immunodeficiency
  Pregnancy