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Abstract

Background: Immune Thrombocytopenia (ITP) is an acquired autoimmune disorder that has a combination of suppressed platelet production and immune mediated platelet destruction. Despite the presence of thrombocytopenia, chronic ITP patients have a higher risk of arterial or venous thromboembolism compared to normal people.

Case presentation: A 37 year old female with a history of steroid resistant chronic ITP presented with severe abdominal pain and massive hematochezia. Upper GI bleeding was diagnosed through nasogastric tube aspiration and esophagogastroduodenoscopy. An abdominal CT scan revealed extensive superior mesenteric vein thrombosis, and small bowel and liver ischemia. She had undergone surgical thrombectomy and small bowel resection. During the hospitalization, she was treated with steroid therapy as well as anticoagulants. Eventually, she required a splenectomy because of a consistent low platelet count. Her platelet count is now stable, and she no longer requires any therapeutic interventions for ITP.

Conclusion: This case is one of the few cases that were reported as paradoxical venous thrombosis in ITP patients. Although arterial and venous thrombosis are considered a rare but potentially life threatening complication of ITP, the therapeutic approach is challenging due to the lack of recommendations and guidelines on the treatment of thrombosis in ITP patients.

Keywords: Immune thrombocytopenia; Mesenteric vein thrombosis; Ischemic hepatitis; Intracranial hemorrhage