The patient was a woman, 35 years old, who showed marked thrombocytopenia and decreases of megakaryocytes since 2 years. Hemorrhagic disorders was recovered by blood transfusion and adrenocorticosteroid treatment. As marked thrombocytopenia and hemorrhagic diathesis, which developed thereaffer, were not ameliorated by similar therapy, splenectomy was performed. Although a rise in platelets was observed, she showed increased sedimentation rate of erythrocyte, generalized lymph nodes, erythema and swelling of joint with pain after 4 months. Laboratory examination revealed increases of γ-globulin and IgG in serum protein, positiv CRP and RA test, LE cells and ANF. Finally, she died with evidence of mental and neurologic dysfunction.
In the extipated spleen, hyperplastic follicle and angitis (3-4 grades) hyperplasia of media, and interruption of collagen in blood vessels were found, although onion skin lesion was not detected.
In the cutaneous tissue, small vessels were surrounded by infiltrated lymphocyte.
From clinical course, it is considered that ITP develop, preceeding by several months other obvious manifestation of SLE which occurred after splenectomy.