Idiopathic Thrombocytopenic Purpura after Mastectomy and Axillary Lymph Node Dissection

First described in 1916, idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease resulting in the destruction of platelets. Here, we present a case of an 85-year-old patient diagnosed with invasive ductal carcinoma of the breast whose surgical treatment was complicated postoperatively by acute-onset thrombocytopenia with a resultant hematoma at the operative site. Diagnostic Workup revealed no clear etiology for the thrombocytopenia; therefore, a presumptive diagnosis of idiopathic thrombocytopenic purpura was made. Previous literature has associated the development of idiopathic thrombocytopenic purpura with breast cancer. However, to the authors’ knowledge, there are no reported cases of ITP presenting immediately following surgical intervention for breast cancer in the absence of other etiologic factors. 1. Introduction Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease, first described in 1916 [1], in which autoantibody production results in destruction of platelets and thrombocytopenia [2]. Prior reports of ITP in patients diagnosed with breast cancer exist where ITP preceded the diagnosis of breast cancer [3] or occurred during adjuvant therapy [4, 5] or metastatic breast cancer was discovered upon therapeutic splenectomy for ITP [6]. Here, we report a case of idiopathic thrombocytopenic purpura which presented after mastectomy for invasive ductal carcinoma. 2. Case Report An 85-year-old Caucasian, postmenopausal female presented to the outpatient clinic with a palpable mass in her left breast. Initial diagnostic mammography identified spiculation and architectural distortion inferior to the 2.1 cm mass at the 12 o’clock position of the left breast. Targeted left breast ultrasound demonstrated two distinct hypoechoic lesions in the 12:00 axis of her left breast, which was classified as BIRADS-5. Ultrasound-guided biopsy revealed invasive ductal carcinoma (ER positive, PR positive, and Her2-Neu negative) in three different areas within her left breast. Left modified radical mastectomy with sentinel lymph node biopsy and axillary lymph node dissection was performed. Three of six sentinel lymph nodes were found to be positive on frozen section (one with macrometastasis and two with micrometastasis), and a full axillary lymph node dissection was performed. The patient was convalescing satisfactorily until the afternoon of postoperative day one, when the output of her surgical drains became sanguineous and voluminous. A pressure dressing was applied to the chest wall. On postoperative day two, her hemoglobin had dropped to