Dr. Srivastava, Sumit
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My 57-year-old mother was diagnosed with tuberculosis (TB) two months ago based on exclusion, as her initial tests returned negative. However, she exhibited symptoms such as enlarged lymph nodes in the chest, low fever, and night sweats. A biopsy ruled out lymphoma and sarcoma.
She was on anti-tuberculosis treatment (ATT), but after ten days, she developed rashes, causing the doctor to stop the medication. After a break for 10 days, she was advised to restart ATT. But she experienced purpura (purple spots on the skin) and started bleeding from her nose and coughing. Her tests revealed platelet count to be 10,000. It has been ten days since then, and she has received intravenous immunoglobulin (IVIG), steroids, and single donor platelets (SDP) as needed, but her platelet count remains below 10,000. Other test results, including the bone marrow biopsy, have returned normal. Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Based on the analysis of your reports (attachment removed to protect the patient's identity), the bone marrow report indicates that there are normal megakaryocytes present, which suggests that the bone marrow is producing large platelets. However, the conversion of these large platelets to normal-sized platelets is inhibited, most likely due to Capsule Rifampicin (antibiotic). In some cases, drugs like INH (Isoniazid) can also cause drug-induced thrombocytopenia. Based on the findings, there is no evidence of lymphoma (cancer of lymphatic tissue) or metastasis (spreading of cancer). Therefore, I suggest you temporarily discontinue Rifampicin in the anti-tuberculosis treatment (ATT) regimen. The administration of steroids and immunoglobulins will increase platelet counts. It is important to note that in elderly individuals, platelets may take longer to increase. Additionally, you can consider administering thrombocyte suspension.
It was a pleasure to help you, and I look forward to helping you further with your medical needs.
Thank you.
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Internal Medicine
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