Acute disseminated encephalomyelitis during treatment for idiopathic thrombocytopenic purpura

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  • 治療中に急性散在性脳脊髄炎を合併した特発性血小板減少性紫斑病
  • 症例報告 治療中に急性散在性脳脊髄炎を合併した特発性血小板減少性紫斑病
  • ショウレイ ホウコク チリョウチュウ ニ キュウセイ サンザイセイ ノウセキズイエン オ ガッペイシタ トクハツセイ ケッショウバン ゲンショウセイ シハンビョウ

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Abstract

A 54-year-old woman had an episode of sudden oral bleeding and generalized petechiae 1 week after a sore throat and diarrhea. On admission, the platelet count was 0.1×104/μl, and the platelet-associated IgG level was elevated. Hyperplasia of megakaryocytes in a bone marrow specimen and aberrant Epstein-Barr virus (EBV) antibody patterns led to a diagnosis of EBV-associated idiopathic thrombocytopenic purpura (ITP). Prednisolone (PSL) promptly restored her platelet count; however, she developed disorientation and affective lability soon after PSL was tapered. Subsequently, she ran a high fever and developed convulsive seizures. T2-weighted MRI demonstrated a high signal area in the subcortical white matter, and no abnormal findings were found on examination of the cerebrospinal fluid. The diagnosis of acute disseminated encephalomyelitis (ADEM) was made and steroid pulse therapy was started, which resulted in remission of the symptoms without recurrence in the following months. This is the first reported case of ADEM following EBV infection during treatment for ITP. Administration of PSL for ITP might mask the presenting clinical picture of ADEM. The possibility of ADEM should be investigated in patients of ITP following viral infection who develop acute encephalopathy.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 49 (7), 505-509, 2008

    The Japanese Society of Hematology

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