Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption
Abstract
Severe thrombocytopenia is a frequent but diagnostically challenging complication in people living with human immunodeficiency virus (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 (ITP) 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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BibTeX
@article{okaya2026severe,
title = {{Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption}},
author = {Shuichi Okaya and Hiroshi Ito and Tomoya Shiba and Yoko Kurihara and Keiichiro Hattori and Mayu Inoue and Dongmei Ma and Satoru Kawano and Nobutake Shimojo},
journal = {Internal Medicine},
year = {2026},
month = oct,
doi = {10.2169/internalmedicine.7009-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/20/65_7009-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption
AU - Shuichi Okaya
AU - Hiroshi Ito
AU - Tomoya Shiba
AU - Yoko Kurihara
AU - Keiichiro Hattori
AU - Mayu Inoue
AU - Dongmei Ma
AU - Satoru Kawano
AU - Nobutake Shimojo
PY - 2026
DA - 2026/10/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.7009-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/20/65_7009-25/_article
AB - Severe thrombocytopenia is a frequent but diagnostically challenging complication in people living with human immunodeficiency virus (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 (ITP) 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.
SN - 1349-7235
SN - 0918-2918
ER -