Therapeutic approach to immune thrombocytopenia: a challenge between standard protocols and refractory cases, between primary idiopathic and secondary forms – case report

Immune thrombocytopenia (ITP) is an autoimmune con­di­tion characterized by an isolated low platelet count. A positive diagnosis may be sometimes difficult, and re­quires extensive investigations to differentiate primary from secondary forms. The most common underlying con­di­tions associated with ITP are infections, malignancy, au­to­im­mune diseases (systemic lupus erythematosus and an­ti­phos­pho­li­pid syndrome, rheumatoid arthritis) or drug in­take. In this article, we present the case of a patient with pri­mary ITP associated with an underlying autoimmune back­ground, who did not respond to first-line treatment with corticosteroids, but with a spectacular recovery after sple­nec­to­my. Because of high heterogeneity, clinical and im­mu­no­lo­gi­cal features of ITP associated with autoimmune di­sease predisposition need to be clarified for establishing a correct attitude towards diagnosis and therapeutic ma­nage­ment.