Ichimata S, Kobayashi M, Honda K, Shibata S, Matsumoto A, Kanno H. Acquired amegakaryocytic thrombocytopenia previously diagnosed as idiopathic thrombocytopenic purpura in a patient with hepatitis C virus infection. World J Gastroenterol 2017; 23(35): 6540-6545 [PMID: 29085203 DOI: 10.3748/wjg.v23.i35.6540]
Corresponding Author of This Article
Mikiko Kobayashi, MD, PhD, Department of Pathology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. mikko@shinshu-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shojiro Ichimata, Mikiko Kobayashi, Kohei Honda, Hiroyuki Kanno, Department of Pathology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
Soichiro Shibata, Akihiro Matsumoto, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
Author contributions: Ichimata S and Kobayashi M performed the histological evaluation, analyzed the serum sample, and drafted the manuscript; Honda K analyzed the serum sample; Shibata S and Matsumoto A evaluated clinical data; Kanno H performed the histological evaluation, analyzed the serum sample, and critically reviewed the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standard at Shinshu University School of Medicine.
Informed consent statement: All study participants, or their legal guardian, provided informed consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mikiko Kobayashi, MD, PhD, Department of Pathology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. mikko@shinshu-u.ac.jp
Telephone: +81-263-372607 Fax: +81-263-372609
Received: May 18, 2017 Peer-review started: May 18, 2017 First decision: June 22, 2017 Revised: July 6, 2017 Accepted: August 8, 2017 Article in press: August 8, 2017 Published online: September 21, 2017 Processing time: 127 Days and 5 Hours
Abstract
We report the first case of a patient with hepatitis C virus (HCV) infection and idiopathic thrombocytopenic purpura (ITP), who later developed acquired amegakaryocytic thrombocytopenia (AAMT), with autoantibodies to the thrombopoietin (TPO) receptor (c-Mpl). A 64-year-old woman, with chronic hepatitis C, developed severe thrombocytopenia and was diagnosed with ITP. She died of liver failure. Autopsy revealed cirrhosis and liver carcinoma. In the bone marrow, a marked reduction in the number of megakaryocytes was observed, while other cell lineages were preserved. Therefore, she was diagnosed with AAMT. Additionally, autoantibodies to c-Mpl were detected in her serum. Autoantibodies to c-Mpl are one of the causes of AAMT, acting through inhibition of TPO function, megakaryocytic maturation, and platelet formation. HCV infection induces several autoantibodies. HCV infection might also induce autoantibodies to c-Mpl, resulting in the development of AAMT. This mechanism may be one of the causes of thrombocytopenia in patients with HCV infection.
Core tip: Thrombocytopenia occurs frequently in patients with hepatitis C virus (HCV) infection. Acquired amegakaryocytic thrombocytopenia (AAMT) is one of the causes of severe thrombocytopenia. The exact mechanisms of AAMT have not been fully elucidated. However, patients with autoantibodies to thrombopoietin receptor (c-Mpl) develop AAMT. Similarly, autoantibodies are sometimes generated in patients with HCV infection. Here, we report the first case of a patient with HCV infection who later developed AAMT with autoantibodies to c-Mpl. AAMT with autoantibodies to c-Mpl may be one of the causes of thrombocytopenia in patients with HCV infection.
