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This case explores the diagnostic challenges of severe thrombocytopenia in a patient with HIV after stopping antiretroviral therapy.

March 5, 2026Internal Medicine0 citationsOpen Access

Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption

SOShuichi OkayaUniversity of Tsukuba Hospital HIHiroshi ItoUniversity of Tsukuba Hospital TSTomoya ShibaKyushu Institute of Technology

Key Points

This case explores the diagnostic challenges of severe thrombocytopenia in a patient with HIV after stopping antiretroviral therapy.
Case report of a 43-year-old woman living with HIV.
Bone marrow aspiration to assess cell composition.
Treatment with intravenous immunoglobulin and high-dose corticosteroids.
Identification and eradication of Helicobacter pylori.
Patient had severe thrombocytopenia and hematochezia after stopping therapy.
Bone marrow showed hypocellular fatty marrow but preserved leukocyte counts.
Treatment led to recovery of platelet count without transfusion.
H. pylori infection was identified and successfully treated.

Abstract

Severe thrombocytopenia is a frequent but diagnostically challenging complication in people living with HIV (PLWH). We report the case of a 43-year-old woman with HIV who developed life-threatening hematochezia and profound thrombocytopenia after the interruption of antiretroviral therapy. Although bone marrow aspiration showed hypocellular fatty marrow, preserved leukocyte counts and the overall clinical context supported immune thrombocytopenia secondary to uncontrolled HIV replication. Treatment with intravenous immunoglobulin and high-dose corticosteroids led to independent transfusion and platelet recovery. Helicobacter pylori infection was identified and eradicated. This case highlights the fact that hypocellular marrow findings mimicking bone marrow failure do not exclude ITP in PLWH.

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