Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption.
Shuichi Okaya, Hiroshi Ito, Tomoya Shiba et al.
✦ AI-curated · Sources linked
Case in brief
A 43-year-old woman living with HIV presented with life-threatening hematochezia and profound thrombocytopenia after interrupting antiretroviral therapy. Bone marrow aspiration showed hypocellular fatty marrow, raising concern for marrow failure, but preserved leukocyte counts and the clinical context supported immune thrombocytopenia associated with uncontrolled HIV replication. Intravenous immunoglobulin and high-dose corticosteroids were followed by recovery of platelet counts without transfusion. Helicobacter pylori infection was also identified and eradicated.
What made this case unusual
The hypocellular fatty marrow mimicked bone marrow failure despite a clinical diagnosis of immune thrombocytopenia.
Diagnostic / clinical pearl
In a person with HIV and severe thrombocytopenia, hypocellular marrow does not by itself exclude immune thrombocytopenia; interpret marrow findings alongside blood counts and the clinical context.