The case study of a 30-year-old African American man who presented with severe immune thrombocytopenia (ITP) only a month after being diagnosed with sarcoidosis is detailed in a report published in Cureus.
The report is the earliest temporal presentation of concurrent ITP and sarcoidosis in an African American male patient reported in the literature. Although a similar case of a young man was presented in another study, the authors state that he was slightly older and had superimposed focal segmental glomerulosclerosis and a 5-year history of sarcoidosis.
Read more about ITP epidemiology
Sarcoidosis often occurs an average of 48 months prior to ITP onset, according to previous research. Another study found that the average ITP onset after sarcoidosis onset was 6 to 216 months. Of the 20 patients in that study, 5 had simultaneous onset of ITP and sarcoidosis.
The patient in the current study presented with a sudden onset of buccal mucosa and mucocutaneous bleeding. He also had dyspnea, mediastinal and hilar adenopathy, and thrombocytopenia with a platelet count of 4000/μL. The patient received 2 units of platelets in the emergency department, but his platelet count fell to 1000/μL.
After 3 days and 7 platelet infusions, the patient’s platelet count remained at 1000/μL, so treatment with romiplostim was initiated at 5 mg/kg to stimulate platelet production. Platelet count increased to 6000/μL on hospital day 4.
Although first-line therapy for ITP includes steroids, this treatment was withheld due to suspicion of mediastinal lymphoma and because steroid use prior to biopsies can interfere with pathological accuracy.
After differential diagnosis was negative for other possible diseases, the patient was diagnosed with ITP, most likely secondary to sarcoidosis, and was started on prednisone at 60 mg daily. His platelet count increased to 136,000/μL at the time of discharge.
“The clinical diversity of sarcoidosis often leads to diagnostic uncertainty and treatment delays due to its resemblance to other more common disorders,” the authors said.
Pasli M, Lovell KK, Vulasala SSR, et al. Severe thrombocytopenia in a 30-year-old African American male with newly diagnosed sarcoidosis: a case report. Cureus. Published online January 24, 2023. doi:10.7759/cureus.34135