The Uncommon Association between Typhoid Fever and Immune Thrombocytopenic Purpura

Abstract

Aims: To report an uncommon and underreported association between immune thrombocytopenic purpura and typhoid fever and review the available literature. Presentation of Case: We present a 19 year-old female with two weeks of vaginal and gastrointestinal bleeding. At the time of presentation, fever, pallor, petechial lesions, ecchymosis and hepatosplenomegaly were noted. Initial workup for associated secondary viral infections were negative, hematologic studies were undertaken. Immune thrombocytopenic purpura was diagnosed and treatment with prednisone initiated. Nonetheless, after initial improvement, fever recurred and Salmonella typhi was isolated on blood culture, after treatment with ciprofloxacin symptoms disappeared with good evolution after outpatient follow-up. Discussion: Immune thrombocytopenic purpura is commonly associated to several viral and some bacterial infections, yet Salmonella typhi has not been consistently proved to be associated. A growing body of literature shows that a diverse variety Salmonella sp. presentation can be associated to immune thrombocytopenic purpura. Both diseases reverse after antibiotic treatment. Conclusion: Typhoid fever should be included in the differential diagnosis when other causes of immune thrombocytopenic purpura have been discarded and clinical presentation is suggestive.