We present a 27-year-old female patient received for epistaxis associated
with gingivorrhagia. In her medical history, she had undergone an oesogastroduodenal fibroscopy one year earlier, which revealed a bulbar ulcer with gastritis. On
admission, she presented with a bleeding syndrome, an anemic syndrome with poor hemodynamic tolerance, and epigastric sensitivity. The blood count
performed in the emergency on the citrate tube showed a bicy-topenia (regenerative anemia + thrombocytopenia).
The HELIKIT test was positive. Thus, the hypothesis of an acute immunological
thrombocytopenic purpura associated with a Helicobacter pylori infection seemed
to us the most probable with a Khellaf hemorrhagic score of 8. She had
benefited from a bolus of methyl prednisone: 15 mg/kg/day for 3 days then relay
per os with prednisone 1 mg/kg/day (and adjuvant treatment); the eradicating
treatment of Helicobacter pylori had been simultaneously started.
References
[1]
Lambert, M.P. and Gernsheimer, T.B. (2017) Clinical Updates in Adult Immune Thrombocytopenia. Blood, 129, 2829-2835. https://doi.org/10.1182/blood-2017-03-754119
[2]
Godeau, B. (2013) Actualités du purpura thrombopénique immunologique. Revue Francophone des Laboratoires, 2013, 14-18. https://doi.org/10.1016/S1773-035X(13)71848-3
[3]
Audia, S., Lorcerie, B., Godeau, B. and Bonnotte, B. (2011) Pathophysiology of immune thrombocytopenia. La Revue de Médecine Interne, 32, 350-357. https://doi.org/10.1016/j.revmed.2009.05.017
[4]
Cines, D.B., Liebman, H. and Stasi, R. (2009) Pathobiology of Secondary Immune Thrombocytopenia. Seminars in Hematology, 46, S2-S14. https://doi.org/10.1053/j.seminhematol.2008.12.005
[5]
Michel, M., Lega, J.-C. and Terriou, L. (2021) Secondary Immunologic Thrombocytopenic Purpuras in Adults. La Revue de Médecine Interne, 42, 50-57. https://doi.org/10.1016/j.revmed.2020.08.004
[6]
Mbengue, M., Diouf, M.L., Dangou, J.M., Ka, M.M., Ba-Seck, A., Ndiaye, M.F., et al. (1997) Frequency of Helicobacter Pylori Infection in Symptomatic Patients in Senegal. Medecine Tropicale: Revue du Corps de Sante Colonial, 57, 256-258.
[7]
de Korwin, J.-D. (2008) Does Helicobater pylori Infection Play a Role in Extragastric Diseases? La Presse Médicale, 37, 525-534. https://doi.org/10.1016/j.lpm.2007.07.029
[8]
Korwin, J.-D. (2013) New Recommendations for the Diagnosis and Treatment of Helicobacter pylori Infection. La Presse Médicale, 42, 309-317. https://doi.org/10.1016/j.lpm.2012.07.014
[9]
Andoulo, F.A., Noah Noah, D., Tagni-Sartre, M., Ndjitoyap, E.C. and Ngu Blackett, K. (2013) Epidémiologie de l’infection à Helicobacter pylori à Yaoundé: de la particularité à l’énigme Africaine. Pan African Medical Journal, 16, Article 115. https://doi.org/10.11604/pamj.2013.16.115.3007
[10]
Khellaf, M., Limal, N., Mahevas, M., Languille, L., Bierling, P., Michel, M., et al. (2009) Helicobacter pylori et Purpura thrombopénique immunologique (PTI): résultats d’une enquête prospective monocentrique sur la prévalence de l’infection et l’effet de l’éradication sur l’évolution du PTI. La Revue de Médecine Interne, 30, S350-S351. https://doi.org/10.1016/j.revmed.2009.10.075
[11]
Emilia, G., Luppi, M., Zucchini, P., Morselli, M., Potenza, L., Forghieri, F., et al. (2007) Helicobacter pylori Infection and Chronic Immune Thrombocytopenic Purpura: Long-Term Results of Bacterium Eradication and Association with Bacterium Virulence Profiles. Blood, 110, 3833-3841. https://doi.org/10.1182/blood-2006-12-063222
