Immune Thrombocytopenia Induced by Helicobacter pylori Infection: A Case Report and Literature Review

Abstract

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by the production of autoantibodies targeting platelet membrane antigens, leading to platelet destruction by the reticuloendothelial system. This results in a significant drop in platelet count to 100 × 10⁹/L or lower due to the formation of autoantibodies and immune complexes. Some studies suggest a potential link between Helicobacter pylori infection and ITP. This report presents a case of ITP in a patient with an H. pylori infection. To our knowledge, this is one of the unique and interesting reported cases of such a severe platelet deficiency, where the platelet count dropped to 1,000 cells/µL in the presence of an aggressive H. pylori infection. A 46-year-old male was admitted with mild gum bleeding and petechiae on his lower limbs. His medical history included chronic diabetes mellitus, dyslipidemia, and hypertension, though his clinical and vital signs were normal. Laboratory tests revealed a critically low platelet count of 3,000 cells/µL, leading to a provisional diagnosis of ITP. The patient was started on intravenous (IV) methylprednisolone (1 g for three days), IV immunoglobulin (0.4 g/kg for five days), proton pump inhibitors, calcium, and vitamin D supplements. However, there was no significant response to the treatment. Additional immunological and viral tests yielded negative results. Given this, an H. pylori test was conducted, which confirmed an infection. The patient was started on H. pylori eradication therapy. The platelet count improved to 48,000 cells/µL, but it dropped again to 1,000 cells/µL after a few days. Various treatment strategies were implemented to manage both ITP and H. pylori. After two months, the H. pylori urea breath test returned negative, and the patient's platelet count normalized. The patient was maintained on folic acid (5 mg daily) and eltrombopag (50 mg daily), with regular hematology follow-ups ensuring stable platelet levels. This case underscores a rare presentation of ITP associated with severe thrombocytopenia (1,000 cells/µL) and aggressive H. pylori infection. The findings emphasize the importance of considering H. pylori in the differential diagnosis of ITP and highlight the necessity of identifying underlying causes for effective treatment.