口腔出血を初発とし急激な経過をたどった特発性血小板減少性紫斑病の1例

抄録

Idiopathic thrombocytopenic purpura （ITP） causes gingival bleeding as an initial symptom and therefore the patients often visit a dentist. We report a case of idiopathic thrombocytopenic purpura that started as oral bleeding and developed into cerebral hemorrhage three days later. The patient was an 81-year-old man. He visited our clinic with persistent gingival bleeding that had occurred while he was cleaning his interdental spaces with a toothpick. He had multiple purpura in the upper extremities and petechiae in the lower extremities. Blood tests showed a platelet count as low as 3,000/mm³. The patient was then referred to the hematology clinic in another hospital where bone marrow aspiration revealed the diagnosis of ITP. The patient was hospitalized and treatment with prednisolone DIV 1mg/kg/day was started on the same day. The following day, the platelet count showed no increase, and the patient developed marked oral bleeding. Therefore, high-dose gamma globulin was administered concomitantly. On the second day of treatment, the patient developed hemiparesis of the left side, and head CT revealed extensive cerebral hemorrhage on the right side. Due to deterioration of his general condition, he died on the third day of treatment.