Immune thrombocytopenic purpura secondary to tuberculosis


  • Rishab Bharadwaj Department of Hemato-Oncology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
  • Deenadayalan Munirathnam Department of Hemato-Oncology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
  • Somu Sivabalan Department of Pulmonology, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India



Immune thrombocytopenic purpura, Tuberculosis, Tuberculous lymphadenitis


Immune thrombocytopenic purpura (ITP) is a clinical syndrome characterized by reduced number of circulating platelets. The cause of ITP remains unknown in most cases, although it can be triggered by a viral infection or other immune trigger. Although tuberculosis is associated with a wide range of hematological manifestations, ITP secondary to tuberculosis is a very rare manifestation, especially in children. We describe an 11-year-old female child who presented with skin and mucosal bleeds, thrombocytopenia and chronic submandibular lymphadenitis. Blood and bone marrow investigations were suggestive of ITP. She received IVIg, but response was unsatisfactory, hence she was started on steroids. Concurrently, GeneXpert of lymph node biopsy was positive for tuberculosis. A diagnosis of ITP secondary to tuberculous lymphadenitis was made. She received 6 months of anti-tuberculosis therapy. Steroids were tapered and stopped within 2 months. She responded well with restoration of normal platelet counts and regression of lymphadenopathy. Tuberculosis should be considered as one of the secondary causes of ITP, especially in highly endemic countries.


World Health Organization. Global tuberculosis report. 2016. Available at:

Kashyap R, Chaudhary VP. Haematological manifestations of tuberculosis. Tuberculosis, New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2006;370-9.

Kakil IR, Mubarak AA, Al Suob H, Burney MA, Al Azawi SH, Aboudi K. Tuberculosis presenting as immune thrombocytopenia: a case report and review of the literature. Qatar Med J. 2006;2006(1):20.

Goldenberg AS. Hematologic abnormalities and mycobacterial infections. Tuberculosis. 1996:645-55.

Madkaikar M, Ghosh K, Jijina F, Gupta M, Rajpurkar M, Mohanty D. Tuberculosis and immune thrombocytopenia. Haematol. 2002;87(8):ELT38.

Bakhshi S, Kabra M, Iyer VK, Arya LS. Thrombocytopenic purpura as a presenting manifestation of tubercular lymphadenitis. Indian J Pediatr. 2003;70(12):993-4.

Krishnamurthy S, Yadav S. Immune thrombocytopenic purpura as a presentation of childhood tuberculosis. Indian J Pediatr. 2007;74(9):853-5.

Singh SP, Misra GC, Prusty PK, Das RK. Tubercular lymphadenitis with purpura. J Indian Med Assoc. 1986;84:247-9.

Jurak SS, Aster R, Sawaf H. Immune thrombocytopenia associated with tuberculosis. Clinic Pediat. 1983;22(4):318-9.

Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346(13):995-1008.

Boots RJ, Roberts AW, McEvoy D. Immune thrombocytopenia complicating pulmonary tuberculosis: case report and investigation of mechanisms. Thorax. 1992;47(5):396-7.

Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.