Abstract
A 69-year-old woman had undergone a right partial mastectomy and axillary lymph node dissection for right breast cancer at the age of 52 years. The diagnosis was scirrhous cancer, T1N2M0 Stage IIIA, ER+, PgR-, HER2 score 0. She received postoperative radiotherapy, cyclophosphamide methotrexate fluorouracil (CMF) chemotherapy, and hormonal treatment, and there was no recurrence at 10 years.
However, at the age of 66 years, the patient was diagnosed with multiple bone metastases and bone marrow carcinomatosis due to breast cancer, and chemotherapy was started. At the age of 67 years, she was diagnosed with brain metastases and meningeal carcinomatosis. She then received whole-brain irradiation and intrathecal chemotherapy, but acute thrombocytopenia developed 1.5 months later.
The thrombocytopenia was attributed to the worsening bone marrow carcinomatosis and bone marrow suppression by drug therapy. However, the platelet counts did not improve despite daily platelet transfusions. In considering the differential diagnosis, PA-IgG levels were found to be high. Therefore, autoimmune thrombocytopenia was suspected, and prednisolone (PSL) 60 mg/day was then started. The platelet counts began to improve dramatically the following day, and later that year, the patient was able to recuperate at home.
Some patients with end-stage cancer require transfusions, but some patients can also be weaned from transfusions, depending on their underlying condition.
