An Autopsy Case of Adult ITP with A Fatal Outcome

Abstract

We describe a rare case of fatal outcome in an adult patient with idiopathic thrombocytopenic purpura (ITP). A 27-year-old female was admitted to Osaka University Hospital on July 15, 1983, at the 9th day from an abrupt appearance of fever and generalized bleeding tendency including epistaxis, petechiae and gingival bleeding. She was diagnosed as having ITP by the decreased platelet count (0.5×10⁴/μl), hypercellular bone marrow with immature megakaryocytes and elevated level of platelet-associated IgG. Intensive therapy with corticosteroid, high doses of gammaglobulin, platelet transfusions and plasma exchange, did neither increase the platelet count nor improve her condition. She became unconscious on July 17, and died of intracranial bleeding on July 21. Autopsy findings supported the diagnosis of ITP, excluding the possibility of DIC or TTP. This case is an exceptionally severe case, which followed a clinical course of fulminant ITP with severe hemorrhagic diathesis resistant to any treatment. The high fever which persisted during the entire course remains unexplained. This fever might be related to the pathogenesis of the rapidly deteriorating course.