TITLE:
Immune Thrombocytopenia Purpura (ITP) with Grave’s Disease, in a Plasmodium Vivax Positive Patient. A Case Report
AUTHORS:
Syed Mohammad Mazhar Uddin, Aatera Haq, Zara Haq, Uzair Yaqoob
KEYWORDS:
Immune Thrombocytopenia Purpura, Malaria, Hyperthyroidism
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.7 No.2,
February
13,
2018
ABSTRACT: Hyperthyroidism and thrombocytopenia have long been associated with each other. We present a case of 38 years old female presenting with complaints of bleeding from gums, bleeding per rectum, hematuria and easy bruising since 7 days ago. She also had a diffuse, non-tender neck swelling moving with deglutition and positive bruit on auscultation. Her laboratory results indicated thrombocytopenia (22 × 10^9/L) and her thyroid function test revealed TSH of 0.01 mIU/ml (normal: 0.17 - 4.05), free T3 of 19.19 pg/ml (normal: 1.6 - 3.7), free T4 of 4.09 ng/dl (normal: 0.89 - 1.79). Thyroid scan showed diffuse goiter with increased tracer uptake. Furthermore, her serum anti-thyroglobulin and anti-thyroid peroxide were elevated to 205 IU/ml and 713 IU/ml respectively. She was started on carbimazole and methylprednisolone immediately. On the 3rd day of admission, she was tested to be positive for Plasmodium Vivax after a fever spike and was started on Chloroquine (CQ) and later shifted to Primaquine (PQ). During 2 weeks of admission, her platelet count kept fluctuating between