Multiple recurrence of acute idiopathic thrombocytopenic purpura.

Takayuki Takahashi, MD, Second Department of Internal Medicine, Faculty of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606 (Japan) Acute idiopathic thrombocytopenic purpura (acute ITP) is characterized by the sudden onset of severe throm-bocytopenia following an infection which is usually of viral origin, and spontaneous resolution of the thrombocytope-nia is the general rule. The recovery of the disease is usually permanent, but multiple recurrences have been reported in some exceptional patients [1-3]. A 41-year-old man presented to our hospital with generalized petechial hemorrhages on March 28, 1984. Two days earlier, he had developed a common cold with symptoms of sore throat, dry cough, and a temperature of 38.2 °C. He had not taken any medications prior to the onset of hemorrhage. Physical examination showed a typical feature of common cold. Laboratory examinations revealed a platelet count of 20 × 109/1 and a white cell count of 10 × 109/1 (61% neutrophils, 7% monocytes, 4% eosino-phils, 26% lymphocytes, and 2% atypical lymphocytes). The hemoglobin concentration was 16.3 g/dl. Examination of the coagulation system and serum biochemistry gave nonspecific results. The C-reactive protein level was slightly elevated to 1.4 mg/dl (normal: < 0.3 mg). Serologi-cal tests for autoimmune disorders and viral infections were nonspecific. The patient was not given any medications, and 1 week later hematological examination showed complete recovery of the platelet count to 453 × 109/1. The subsequent clinical course of this patient is displayed in figures 1 and 2. Bone marrow aspirates obtained at the second and third attacks of thrombocytopenia showed a moderate reduction of megakaryocyte number without any other abnormalities, whereas that obtained during sustained remission of the disease revealed normal megaka-ryocytopoiesis. At the third attack of thrombocytopenia, oral prednisolone therapy was started because of severe bleeding tendency, and was continued until 1989, when the platelet count remained within normal limits. At the last attack of thrombocytopenia in 1986, the platelet-associated IgG level was 210 ng/l07 platelets (normal range: 9-25 ng) as measured by ELISA [4], whereas the level was 12.0 ng/l07 platelets in November 1989 when the platelet count was normal.