Miliary Tuberculosis With Immune Thrombocytopenia in 50‐Year‐Old Ethiopian Woman: A Case Report and Brief Review of Literature

TL;DR

A 50-year-old Ethiopian woman with miliary tuberculosis developed severe immune thrombocytopenia, which improved after anti-tuberculosis treatment.

Contribution

This case report highlights miliary TB as a reversible cause of immune thrombocytopenia and suggests anti-TB therapy alone can lead to platelet recovery.

Findings

Anti-tuberculosis therapy led to sustained platelet recovery without prolonged immunosuppression.

Miliary TB should be considered in the differential diagnosis of secondary immune thrombocytopenia in endemic regions.

Corticosteroids may be used briefly for severe bleeding while awaiting TB treatment initiation.

Abstract

Immune thrombocytopenia (ITP) is a rare but recognized hematologic complication of tuberculosis (TB), particularly miliary TB. We present a case of a 50‐year‐old female with severe thrombocytopenia and hemorrhagic manifestations secondary to miliary TB. The patient presented with mucocutaneous bleeding, anemia, and constitutional symptoms. Investigations revealed severe thrombocytopenia (11,000/μL), erythroid hyperplasia on bone marrow aspiration, and radiographic findings consistent with miliary TB, later confirmed by sputum GeneXpert. Management included short‐course high‐dose dexamethasone for acute bleeding, followed by anti‐tuberculosis therapy (ATT), which led to sustained platelet recovery without further immunosuppression. This case highlights miliary TB as a reversible cause of secondary ITP and underscores the importance of investigating underlying infections in patients presenting with thrombocytopenia in TB‐endemic regions.

In tuberculosis (TB)‐endemic regions, miliary tuberculosis should be considered a potential cause of severe immune thrombocytopenia. Early diagnosis and initiation of anti‐tuberculosis therapy can lead to complete hematologic recovery, obviating the need for prolonged immunosuppression.

TB should be considered in the differential diagnosis of secondary ITP, particularly in endemic areas and in patients with constitutional symptomsA brief course of corticosteroids may be appropriate for severe bleeding while awaiting ATT initiationATT alone may be sufficient to achieve sustained platelet recovery in TB‐associated ITP.Bone marrow examination may not be necessary when a clear infectious etiology is identified.Long‐term follow‐up is essential to confirm durable remission.

TB should be considered in the differential diagnosis of secondary ITP, particularly in endemic areas and in patients with constitutional symptoms

A brief course of corticosteroids may be appropriate for severe bleeding while awaiting ATT initiation

ATT alone may be sufficient to achieve sustained platelet recovery in TB‐associated ITP.

Bone marrow examination may not be necessary when a clear infectious etiology is identified.

Long‐term follow‐up is essential to confirm durable remission.

Diffuse petechiae and non‐palpable purpura (lower extremities below knee, admission photo).

Figures