쯔쯔가무시병에 동반된 면역성 혈소판 감소증 1예

Abstract

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. In addition to thrombocytopenia, facial palsy and Guillain-Barré syndrome were also reported as immune-mediated phenomena in scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region of both legs. After steroid treatment, the sustained thrombocytopenia recovered. (Korean J Med 2014;86:362-366) Keywords: Scrub typhus; Autoimmune thrombocytopenia; Gastrointestinal hemorrhage

쯔쯔가무시병에서 혈소판 감소증은 흔히 나타나는 혈액학적 이상 소견이며 급성 면역성 혈소판 감소성 자반증은 대부분 바이러스 감염증과 연관되어 있는 것으로 알려져 있 다. 저자들은 쯔쯔가무시병 환자에게서 지속되는 혈소판 감 소증을 면역성 혈소판 감소성 자반증으로 판단하고 스테로 이드 사용 후 호전된 1예를 경험하였기에 이를 보고하는 바이다. 중심 단어: 쯔쯔가무시병; 면역성 혈소판감소성 자반증; 위 장관출혈