특발성혈소판감소성자반증 환자에게 발생한 폐혈전색전증 1예

A Case of Pulmonary Thromboembolism in a Patient with Idiopathic Thrombocytopenic Purpura

일반적으로 특발성혈소판감소성자반증과 같이 혈소판감소증이 있는 경우 출혈합병증이 아닌 심부정맥혈전증이나 폐혈전색전증과 같은 혈전성 질환이 발생하는 것은 드문 현상이다. 하지만 본 증례와 같이 특발성혈소판감소성자반증 환자에서 혈전증이 합병되면서 항인지질증후군이 병발하는 경우가 있으므로 의심증상이 있을 때에는 적극적인 진단 및 치료가 필요하다. 저자들은 특발성혈소판감소성자반증 환자가 하지혈전증 및 폐혈전색전증이 발생하면서 항인지질증후군이 진단되고, 항응고제 및 면억억제제를 동시에 투여하면서 효과적으로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune blood disorder characterized by thrombocytopenia. Common clinical manifestations include bleeding events. Rarely, thrombotic complications may develop in ITP. A 43-year-old man was admitted with dyspnea. His platelet count at admission was 48,000/$mm^{3}$. The patient had a history of ITP diagnosed 12 years earlier and had been treated with low-dose steroids. Two months before admission, he had been diagnosed with deep vein thrombosis and treated only with clopidogrel due to severe thrombocytopenia. Chest computed tomography showed filling defects in both pulmonary arteries. In the workup for precipitating factors, only lupus anticoagulant was positive. The concomitant administration of warfarin and methylprednisolone was used to treat the pulmonary thromboembolism and ITP, respectively. Six months later, the lupus anticoagulant test remained positive. The patient was confirmed to have a pulmonary thromboembolism due to antiphospholipid syndrome, which might be related to the underlying ITP. After 10 months, his symptoms and radiological findings had improved.