Portal Vein Thrombosis during Eltrombopag Treatment for Immune Thrombocytopenic Purpura in a Patient with Liver Cirrhosis due to Hepatitis C Viral Infection
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概要
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Portal vein thrombosis is a rare, aggressive andlife-threatening complication of liver cirrhosis (LC). Eltrombopag is effective for the treatment of chronic hepatitis with thrombocytopenia, andportal vein thrombosis at this time has rarely been reported. We describe the case of a 78-year-old woman who suffered from LC due to hepatitis C viral infection. The patient developed immune thrombocytopenic purpura (ITP) that was diagnosed on the basis of nasal bleeding, progressive severe thrombocytopenia, elevation of platelet-associatedIgG (PAIgG), no response to the transfusion of platelets andno abnormal findings on bone marrow biopsy. Although we first administered prednisolone (0.5 mg/kg/day), there was no recovery of platelet function and the nasal bleeding persisted. Subsequently, we administered eltrombopag for refractory ITP at a dose of 12.5 mg/day, and the thrombocytopenia gradually improved. Fifty-four days after the start of eltrombopag therapy, she developedportal vein thrombosis. Eltrombopag was stoppedimmed iately, andantithrombin III was administeredfor prophylaxis against further portal vein thrombosis. Despite these treatments, there were subsequent deep vein and pulmonary artery thromboses. We then administered heparin for recanalization of the thrombi. One month after the initiation of heparin, there was recanalization as well as improvements of the portal vein, deep vein and pulmonary artery thromboses. There was no further thrombosis progression after switching from heparin to warfarin therapy. Our case suggests that eltrombopag may increase the risk of portal vein thrombosis ; therefore, this drug must be used carefully in the treatment of ITP in patients with LC due to hepatitis C viral infection. [<I>J Clin Exp Hematop 53(2) : 151-155, 2013</I>]
著者
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Muranaka Takahiro
Department Of Physics And Mathematics Aoyama Gakuin University
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Iwakiri Hisayoshi
Department Of Gastroenterology Kyoto University Hospital Kyoto University Graduate School Of Medicin
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Yoshida Shuro
Department Of Internal Medicine Miyazaki Prefectural Miyazaki Hospital
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HASUIKE Satoru
Department of Internal Medicine II, Faculty of Medicine, University of Miyazaki
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NAGATA Kenji
Department of Internal Medicine II, Faculty of Medicine, University of Miyazaki
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Ueda Akira
Department Of Applied Mathematics And Physics Faculty Of Engineering Kyoto University
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Sata Michio
Division Of Clinical Nutrition Shiga University Of Medical Science
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Yamashita Kiyoshi
Department Of Hematology And Oncology Graduate School Of Medicine University Of Tokyo
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Shimoda Kazuya
Department Of Cardiology Jichi Medical School
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Nakamura Kenichi
Department Of Applied Physics School Of Science And Engineering Waseda University
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Kawano Noriaki
Department Of Hematology Harasanshin Hospital
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OKAMURA Takashi
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
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Kuriyama Takuro
Department of Internal Medicine, Miyazaki Prefectural Hospital
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Sata Michio
Division of Gastroenterology, Department of Medicine, and Department of Digestive Disease Information & Research, Kurume University School of Medicine
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Kawaguchi Takumi
Division of Gastroenterology, Department of Medicine, and Department of Digestive Disease Information & Research, Kurume University School of Medicine
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Ozono Yoshinori
Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
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Kusumoto Hisanori
Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
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Kikuchi Ikuko
Department of Internal Medicine, Miyazaki Prefectural Hospital
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Iwakiri Hisayoshi
Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
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Nakamura Kenichi
Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
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Nakamura Kenichi
Department of Applied Chemistry, Faculty of Engineering, Osaka University
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Okamura Takashi
Department of Internal Medicine, Hematology, Kurume University
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Hasuike Satoru
Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
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Nagata Kenji
Department of Internal Medicine, Gastroenterology and Hematology, Faculty of Medicine, Miyazaki University
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Yamashita Kiyoshi
Department of Internal Medicine, Miyazaki Prefectural Hospital
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Yoshida Shuro
Department of Internal Medicine, Miyazaki Prefectural Hospital
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NAKAMURA KENICHI
Department of Anatomy Kurume University School of Medicine
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Okamura Takashi
Department of Chemistry, Faculty of Science, Hokkaido University
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KAWAGUCHI Takumi
Division of Gastroenterology, Department of Medicine and Research Center for Innovative Cancer Therapy of the 21st Century COE Program for Medical Science, Kurume University School of Medicine
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