Severe Immune Thrombocytopenia Associated With Newly Diagnosed Rheumatoid Arthritis and Complicated by a Spontaneous Presacral Haematoma: A Case Report.
- 1Accident and Emergency, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, GBR.
- 2Acute Medicine, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, GBR.
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterised by isolated thrombocytopenia and a variable bleeding phenotype. Patients may be asymptomatic or may present with bleeding ranging from minor skin or mucosal manifestations to uncommon, potentially life-threatening internal haemorrhage. Its occurrence with rheumatoid arthritis (RA) is uncommon, and severe disease may require treatment beyond corticosteroids and intravenous immunoglobulin (IVIG). We report the case of a 64-year-old woman with recently diagnosed seropositive RA who was found to have a platelet count of 0 x 10⁹/L after presenting with a purpuric rash and recurrent epistaxis. Haemoglobin and white cell count were preserved, and investigations did not identify an infectious, malignant, or bone marrow cause. The platelet count remained critically low despite high-dose dexamethasone, two doses of intravenous immunoglobulin (IVIG), and platelet transfusions. Romiplostim was commenced on day 6, producing a progressive platelet response. Cross-sectional imaging undertaken during the admission identified a presacral haematoma with an initially suspected pseudoaneurysm; repeat triple-phase CT showed stability without active bleeding. The patient was discharged on weekly romiplostim, and her platelet count was 197 x 10⁹/L at the 65-day post-discharge follow-up assessment. This case highlights the rare association between RA and ITP, the importance of excluding alternative causes of thrombocytopenia, and the value of early thrombopoietin receptor agonist therapy when first-line rescue treatment is unsuccessful, as well as the rare occurrence of a pre-sacral hematoma with bleeding at an unusual anatomical site as a complication of severe thrombocytopenia.
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BibTeX
@article{win2026severe,
title = {{Severe Immune Thrombocytopenia Associated With Newly Diagnosed Rheumatoid Arthritis and Complicated by a Spontaneous Presacral Haematoma: A Case Report.}},
author = {Nyein Su Win and Wine Ohn Chit},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116964},
url = {https://europepmc.org/article/MED/42936669},
note = {CC BY},
}
RIS
TY - JOUR
TI - Severe Immune Thrombocytopenia Associated With Newly Diagnosed Rheumatoid Arthritis and Complicated by a Spontaneous Presacral Haematoma: A Case Report.
AU - Nyein Su Win
AU - Wine Ohn Chit
PY - 2026
DA - 2026/09/26
JO - Cureus
DO - 10.7759/cureus.116964
UR - https://europepmc.org/article/MED/42936669
AB - Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterised by isolated thrombocytopenia and a variable bleeding phenotype. Patients may be asymptomatic or may present with bleeding ranging from minor skin or mucosal manifestations to uncommon, potentially life-threatening internal haemorrhage. Its occurrence with rheumatoid arthritis (RA) is uncommon, and severe disease may require treatment beyond corticosteroids and intravenous immunoglobulin (IVIG). We report the case of a 64-year-old woman with recently diagnosed seropositive RA who was found to have a platelet count of 0 x 10⁹/L after presenting with a purpuric rash and recurrent epistaxis. Haemoglobin and white cell count were preserved, and investigations did not identify an infectious, malignant, or bone marrow cause. The platelet count remained critically low despite high-dose dexamethasone, two doses of intravenous immunoglobulin (IVIG), and platelet transfusions. Romiplostim was commenced on day 6, producing a progressive platelet response. Cross-sectional imaging undertaken during the admission identified a presacral haematoma with an initially suspected pseudoaneurysm; repeat triple-phase CT showed stability without active bleeding. The patient was discharged on weekly romiplostim, and her platelet count was 197 x 10⁹/L at the 65-day post-discharge follow-up assessment. This case highlights the rare association between RA and ITP, the importance of excluding alternative causes of thrombocytopenia, and the value of early thrombopoietin receptor agonist therapy when first-line rescue treatment is unsuccessful, as well as the rare occurrence of a pre-sacral hematoma with bleeding at an unusual anatomical site as a complication of severe thrombocytopenia.
SN - 2168-8184
ER -