A case of liver cirrhosis type C complicated with acute onset idiopathic thrombocytopenic purpura which was possible to undergo living donor liver transplantation by multidisciplinary therapy

Abstract

A-43-year-old woman was pointed out HCV antibody-positive at the time of 26-year-old and diagnosed with liver cirrhosis type C (LCC) at the time of 41-year-old. She was evaluated as Child-Pugh class C (score: 12) in May 2013. Therefore, she was admitted to our hospital for receiving blood type incompatible living donor liver transplantation (LDLT) in August 2013. On admission, she had presented with bleeding from the gingiva for 4 days before hospitalization, and her platelet count was 2,000/μL. Since the increased megakaryocytes in the bone marrow and high serum platelet-associated IgG (PAIgG) was observed, she was diagnosed as having immune thrombocytopenic purpura (ITP) with LCC. In response to rituximab and intravenous immune globulin therapy, platelet count was quickly improved to 75,000/μL. August 2013, she underwent LDLT and splenectomy. Her postoperative platelet count is 200,000/μl and clinical course is uneventful after LDLT. In Japan, there is no reported case of acute onset ITP with HCV infection before LDLT. We herein report our experience with some bibliographical considerations.