Splenic Primary Follicular Lymphoma With Idiopathic Thrombocytopenic Purpura: Report of a Case

Introduction: Primary splenic lymphoma is a rare condition that accounts for approximately 1% of non-Hodgkin's lymphoma. No primary splenic follicular lymphoma with idiopathic thrombocytopenic purpura (ITP) has been reported in the literature. Case presentation: A 41-year-old man was diagnosed with idiopathic thrombocytopenic purpura (ITP), and received steroid maintenance treatment with oral prednisolone 13 mg/d for 6 years. However, the platelet counts were 20 × 103 /μL or less. Abdominal enhanced computer tomography (CT) revealed splenomegaly. He underwent laparoscopic splenectomy after preoperative high-dose immunoglobulin preparation (30 mg/d intravenously for 5 days) which were effective in the improvement of platelets count (130 × 103 /μL). The histologic diagnosis was B cell type follicular lymphoma of the spleen. Fluorescent in situ hybridization (FISH) revealed a t(14; 18)(q32; q21) translocation, which supported the diagnosis of primary follicular lymphoma of the spleen. After the operation, the patient showed satisfactory recovery, and was discharged on postoperative day 7. He remains well with the platelet count of more than 200 × 103 / μl without medication. We herein report such a case. Conclusion: To the best of our knowledge, this is the first reported case of splenic primary follicular lymphoma with ITP.

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Acute kidney injury and nephrotic syndrome associated with eltrombopag therapy in chronic idiopathic thrombocytopenic purpura

BMJ Case Reports ◽

10.1136/bcr-2020-241462 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241462

Author(s):

Suchi Anindita Ghosh ◽

Jean Patrick ◽

Kyaw Zin Maw

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Nephrotic Syndrome ◽

Idiopathic Thrombocytopenic Purpura ◽

Kidney Injury ◽

High Dose ◽

Chronic Idiopathic Thrombocytopenic Purpura ◽

Thrombocytopenic Purpura ◽

Antibody Screen ◽

Auto Antibody

A 77-year-old man was admitted with severe acute kidney injury and nephrotic syndrome. He was started on eltrombopag for chronic idiopathic thrombocytopenic purpura 6 weeks earlier. An ultrasound of the kidneys was normal and an auto-antibody screen was negative. The use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient’s development of acute renal failure and eltrombopag therapy. Literature review identified only one other case of nephrotic syndrome and acute kidney injury associated with eltrombopag therapy in which a kidney biopsy revealed focal segmental glomerulosclerosis. Due to the challenges faced during the prevailing SARS-CoV-2 pandemic and persistent low platelet counts a renal biopsy was not undertaken. On stopping eltrombopag, the patients renal function stabilised and he successfully went into remission following treatment with high dose corticosteroids and diuretics. This report of a serious case of reversible renal failure and nephrotic syndrome after treatment with eltrombopag may serve to inform clinicians about the possible severe renal adverse effects of eltrombopag before its commencement for future use.

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