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IDIOPATHIC THROMBOCYTOPENIC PURPURA OCCURRING AFTER TOTAL ABDOMINAL COLECTOMY FOR PEDIATRIC ULCERATIVE COLITIS: A CASE REPORT
S Yong, W El-Matary
Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Alberta
Immune thrombocytopenic purpura (ITP) has been described as an extraintestinal manifestation of ulcerative colitis (UC). Previous reports have postulated that total colectomy for UC may be curative for both UC and ITP. We report a pediatric case of ITP occurring after total colectomy for preexisting UC, suggesting that colectomy cannot be seen as curative for ITP.
Our patient, a Jehovah’s witness, initially presented with bloody diarrhea, mild elevation of inflammatory markers, and a hypochromic microcytic anemia. Upper endoscopy and a colonoscopy showed moderate pancolitis. Biopsy results confirmed a diagnosis of ulcerative colitis. He was started on salazopyrine and responded very well. He presented nineteen months later with abdominal pain, bloody diarrhea, worsening anemia and weight loss. Without response to a trial of IV methylprednisolone, and without blood transfusions as a therapeutic option, the patient underwent a total abdominal colectomy for ongoing blood loss and disease control. This followed extensive discussion with the patient’s family and appeared to be the best option. Severe thrombocytopenia followed colectomy, with the patient’s platelet count dropping to a low of 25 × 109/L. A diagnosis of idiopathic thrombocytopenic purpura was made based on a normocellular to slightly hypercellular bone marrow biopsy, an unremarkable bone marrow aspirate, a normal coagulation profile, and the lack of splenomegaly on examination. An immediate course of IVIG resolved the ITP. Three months following discharge, the patient had been weaned off of steroid therapy and continued to do very well.
To our knowledge, there have been no other reported cases of ITP occurring post-colectomy for UC. Given this case, we stress that colectomy cannot be viewed as protective against or curative for ITP.
Key words: ulcerative colitis, immune thrombocytopenic purpura, colectomy, pediatric.