Dhauna Karam, Pant Mukta Purohit, Peter A Morawiecki, Chandra S Mouli
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.
