특발성혈소판감소성자반증 환자에게 발생한 폐혈전색전증 1예
A Case of Pulmonary Thromboembolism in a Patient with Idiopathic Thrombocytopenic Purpura
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
일반적으로 특발성혈소판감소성자반증과 같이 혈소판감소증이 있는 경우 출혈합병증이 아닌 심부정맥혈전증이나 폐혈전색전증과 같은 혈전성 질환이 발생하는 것은 드문 현상이다. 하지만 본 증례와 같이 특발성혈소판감소성자반증 환자에서 혈전증이 합병되면서 항인지질증후군이 병발하는 경우가 있으므로 의심증상이 있을 때에는 적극적인 진단 및 치료가 필요하다. 저자들은 특발성혈소판감소성자반증 환자가 하지혈전증 및 폐혈전색전증이 발생하면서 항인지질증후군이 진단되고, 항응고제 및 면억억제제를 동시에 투여하면서 효과적으로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune blood disorder characterized by thrombocytopenia. Common clinical manifestations include bleeding events. Rarely, thrombotic complications may develop in ITP. A 43-year-old man was admitted with dyspnea. His platelet count at admission was 48,000/mm3. The patient had a history of ITP diagnosed 12 years earlier and had been treated with low-dose steroids. Two months before admission, he had been diagnosed with deep vein thrombosis and treated only with clopidogrel due to severe thrombocytopenia. Chest computed tomography showed filling defects in both pulmonary arteries. In the workup for precipitating factors, only lupus anticoagulant was positive. The concomitant administration of warfarin and methylprednisolone was used to treat the pulmonary thromboembolism and ITP, respectively. Six months later, the lupus anticoagulant test remained positive. The patient was confirmed to have a pulmonary thromboembolism due to antiphospholipid syndrome, which might be related to the underlying ITP. After 10 months, his symptoms and radiological findings had improved. (Korean J Med 2011;81:251-256)
참고문헌 (19)
- Coon WW, "Venous thromboembolism: prevalence, risk factors and prevention", Clin Chest Med, 5, pp.391~401 (1984)
- 인광호, "급성 폐혈전색전증 전국 실태 조사 보고", Tuberculosis and Respiratory Diseases, 54(1), pp.5~14 (2003), 대한결핵및호흡기학회
- Kwaan HC, "Hyperviscosity in polycythemia vera and other red cell abnormalities", Semin Thromb Hemost, 29, pp.451~458 (2003)
- Michiels JJ, "The paradox of platelet activation and impaired function; platelet-von Willebrand factor interactions, and the etiology of thrombotic and hemorrhagic manifestations in essential thrombocythemia and polycythemia vera", Semin Thromb Hemost, 32, pp.589~604 (2006)
- Cines DB, "Management of adult idiopathic thrombocytopenic purpura", Annu Rev Med, 56, pp.425~442 (2005)
- 강규식, "특발혈소판감소자색반병에 동반된 뇌경색", 대한신경과학회지, 24(6), pp.605~607 (2006), 대한신경과학회
- Jun Hyung Kim, "Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction with Idiopathic Thrombocytopenic Purpura: A Case Report", Journal of Korean Medical Science, 21(2), pp.355~357 (2006), 대한의학회
- Paolini R, "Acute myocardial infarction during treatment with intravenous immunoglobulin for idiopathic thrombocytopenic purpura (ITP)", Am J Hematol, 65, pp.177~178 (2000)
- Fruchter O, "Fatal acute myocardial infarction during severe thrombocytopenia in a patient with idiopathic thrombocytopenic purpura", Am J Med Sci, 323, pp.279~228 (2002)
- Pierrot-Deseilligny Despujol C, "Antiphospholipid antibodies in adults with immune thrombocytopenic purpura", Br J Haematol, 142, pp.638~643 (2008)
- Diz-Küçükkaya R, "Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study", Blood, 98, pp.1760~1764 (2001)
- Wilson WA, "International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop", Arthritis Rheum, 42, pp.1309~1311 (1999)
- Kravitz MS, "Thrombocytopenic conditions-autoimmunity and hypercoagulability: commonalities and differences in ITP, TTP, HIT, and APS", Am J Hematol, 80, pp.232~242 (2005)
- Asherson RA, "Multiple autoimmune disease in a young woman: tuberculosis and splenectomy as possible triggering factors? Another example of the “osaic”of autoimmunity", J Rheumatol, 35, pp.1224~1226 (2008)
- Zonana MF, "Coexistence of four autoimmune disease in one patient: the kaleidoscope of autoimmunity", J Clin Rheumatol, 8, pp.322~325 (2002)
- 우태욱, "특발성 혈소판감소성 자반병과 쇼그렌씨 증후군이 동반된 원발성 담즙성 간경변증 1예", 대한내과학회지, 66(1), pp.80~85 (2004), 대한내과학회
- Levene NA, "Chronic active hepatitis following splenectomy for autoimmune thrombocytopenia", Isr J Med Sci, 27, pp.199~201 (1991)
- Ruffatti A, "Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a multicentre, retrospective follow-up study", Ann Rheum Dis, 68, pp.397~399 (2009)
- Iwahara Y, "Thrombocytopenic purpura in a patient with lupus anticoagulant: requirement of both immunosuppressive and antithrombotic therapies", Am J Hematol, 33, pp.75~77 (1990)