Immune Thrombocytopenia in Association with Pancreatic Adenocarcinoma

Abstract

Context: Evaluation for Immune thrombocytopenic purpura leading to diagnosis of advanced pancreatic adenocarcinoma has not been previously reported in literature.  Case report: We present a case of a 72 year old male who presented to our center with epistaxis, hematuria and prolonged bleeding from leg wound. Complete blood count revealed a platelet count of 2 k/uL. A complete physical exam with an extensive work up, ruled out other causes of thrombocytopenia including drugs, infections, liver disease and coagulation disorders. Computed tomography abdomen and pelvis, done as a part of workup to assess for hepatosplenomegaly revealed a pancreatic and a liver mass. Biopsy of liver mass confirmed the diagnosis of pancreatic adenocarcinoma. A trial of intravenous steroids and immunoglobulins quadrupled the platelet count initially, but then platelet count continued to drop. Further treatment with rituximab improved platelet counts to over 100 k/uL. The absence of any apparent cause of thrombocytopenia, coupled with a response to steroids and immunoglobulins initially, and rituximab later, were confirmatory of immune thrombocytopenia.  Conclusion: Immune thrombocytopenic purpura can be the presenting feature of advanced pancreatic adenocarcinoma and our case highlights the importance of a thorough workup that led to diagnosis of pancreatic malignancy. Context: Evaluation for Immune thrombocytopenic purpura leading to diagnosis of advanced pancreatic adenocarcinoma has not been previously reported in literature. Case report: We present a case of a 72 year old male who presented to our center with epistaxis, hematuria and prolonged bleeding from leg wound. Complete blood count revealed a platelet count of 2 k/uL. A complete physical exam with an extensive work up, ruled out other causes of thrombocytopenia including drugs, infections, liver disease and coagulation disorders. Computed tomography abdomen and pelvis, done as a part of workup to assess for hepatosplenomegaly revealed a pancreatic and a liver mass. Biopsy of liver mass confirmed the diagnosis of pancreatic adenocarcinoma. A trial of intravenous steroids and immunoglobulins quadrupled the platelet count initially, but then platelet count continued to drop. Further treatment with rituximab improved platelet counts to over 100 k/uL. The absence of any apparent cause of thrombocytopenia, coupled with a response to steroids and immunoglobulins initially, and rituximab later, were confirmatory of immune thrombocytopenia. Conclusion: Immune thrombocytopenic purpura can be the presenting feature of advanced pancreatic adenocarcinoma and our case highlights the importance of a thorough workup that led to diagnosis of pancreatic malignancy.