B52-33 Refractory Immune Thrombocytopenia Triggered by Rhinovirus Infection Complicated by Subsegmental Pulmonary Embolism Requiring Splenic Artery Embolization in a Young Adult Male

Introduction Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by immune-mediated platelet destruction and impaired megakaryopoiesis. Viral infections are established precipitants of ITP exacerbation, but rhinovirus is rarely reported as a trigger of severe refractory disease. Management becomes increasingly complex when critical thrombocytopenia coexists with thrombosis, limiting anticoagulation and complicating both immunomodulatory and procedural decision-making. Case Presentation A 23-year-old man with chronic ITP on Eltrombopag, hemoglobin SC disease, and a history of pulmonary embolism presented with cough and nasal congestion. Laboratory findings showed profound thrombocytopenia (12 × 10³/µL), neutropenia (ANC 200/µL), and a positive PCR for rhinovirus. He received platelet transfusions, corticosteroids, IVIG, Eltrombopag dose escalation, romiplostim, and filgrastim without substantial platelet response (platelets persistently <30 × 10³/µL).CTA revealed new bilateral subsegmental pulmonary emboli, but anticoagulation was deferred due to critically low platelet counts. Bone marrow biopsy demonstrated dysmegakaryopoiesis without blasts, consistent with peripheral platelet destruction. Given failure to respond to multiple immunomodulatory therapies and the need to address simultaneous thrombotic risk, the patient underwent partial splenic artery embolization (SAE) on hospital day 13. Platelet counts rose rapidly to > 90 × 10³/µL within 72 hours, neutropenia resolved, and anticoagulation was safely reinitiated. He was discharged shortly thereafter with stable hematologic improvement. Discussion This case highlights rhinovirus as a rare but impactful trigger of ITP exacerbation likely mediated through immune complex formation and splenic platelet sequestration. The presence of concurrent thrombosis in a patient with critical thrombocytopenia created a narrow therapeutic window, limiting both anticoagulation and immunosuppression. Partial splenic artery embolization provided a minimally invasive alternative to splenectomy, rapidly restoring platelet counts while preserving partial splenic function and reducing procedural immunologic risk.This case emphasizes the value of SAE in patients with refractory ITP where multiple lines of medical therapy have failed, and concurrent thrombosis complicates management. As a spleen-preserving intervention, SAE offers faster recovery, avoids general anesthesia, and can be performed safely in medically unstable patients.