Immune thrombocytopenia: An uncommon haematological emergency in tuberculosis

Haematological involvement in infections is a common occurrence, with the potential to affect various blood cell lineages, often resulting in cytopenia. Among these, thrombocytopenia is frequently seen. Mycobacterium tuberculosis (MTB) is a well-known infectious agent associated with anaemia, leucocytosis/leukopenia, and thrombocytosis/thrombocytopenia, though severe thrombocytopenia in the context of tuberculosis is relatively uncommon. An unusual manifestation of MTB, such as severe thrombocytopenia, can pose diagnostic challenges with a high risk of fatality. A 31-year-old female presented with fever associated with symptomatic, severe thrombocytopenia, which, after extensive work-up, was diagnosed as disseminated tuberculosis. This was managed as MTB-induced immune thrombocytopenia (ITP) with intravenous immunoglobulin and steroids. The management of ITP in the presence of an underlying infection remains a complex issue, as the approach to treating thrombocytopenia in the context of MTB is not well-defined. The use of corticosteroids in such infections presents a major challenge, requiring careful consideration of the risks and benefits. Additionally, the role of immunotherapy in treating infection-induced thrombocytopenia remains a topic of debate.