Suppl.completo reimpag._4b_. 04/10/13 15:55 Pagina 31
Case Report
Oral submucosal hemorrhage as first clinical manifestation of H.Pylori-Associated Idiopathic Thrombocytopenic Purpura G. Mergoni, A. Sarraj, E. Merigo, P. Vescovi, M. Manfredi Oral Medicine, Pathology and Laser-assisted Surgery Unit, Dentistry Section, SBiBiT Department, University of Parma, Italy A 35-year-old man was referred for a diffuse bleeding of the oral cavity lasting for some days. Medical history was unremarkable and the patient was not taking any drugs. He did not report any pain, fever or fatigue. Petechiae on the surface of the soft palate, spontaneous gingival bleeding and hematoma on the left buccal mucosa was present at clinical examination. No head and neck lymphadenopathy was detected. Several blood test to exclude blood malignancies, coagulopathies or acute viral infections were prescribed. From the blood tests, very low platelets count (12500 plt/ml) was found. No other clinical or laboratory pathological findings were observed. The patient was then referred to the Onco-Hematological Department of the Azienda OspedalieroUniversitaria of Parma. With the working diagnosis of acute idiopathic thrombocytopenic purpura (ITP), other possible causes of trombocypenia, including leukemia, drugs, lupus erythematosus, cirrhosis, HIV, hepatitis C, congenital causes, and von Willebrand factor deficiency were progressively excluded. According to the recent evidence of a possible role of H. pylori in approximately half of the adults with ITP, the patient underwent the 13C-urea breath test, which resulted positive. The H. pylori infection was confirmed with a gastroscopy. The standard triple therapy (clarithromycin, amoxicillin, and a proton pump inhibitor) was maintained for 2 weeks in association with corticosteroids. The eradication of H. pylori infection was confirmed and a return to a normal platelets count was observed in a month along with the disappearing of the oral signs of hemorrhagic diathesis. H. pylori has a well demonstrated role in several gastroduodenal diseases and recently several studies have focused on its possible causal role in various extragastric disorders, including immune TP. The exact mechanisms of H. pylori-induced thrombocytopenia remains unknown, but platelet immunolysis secondary to molecular mimicry has been hypothesized. References • •
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial pathology Philadelphia: Saunders; 2002. Franchini M, et al. Helicobacter pylori-associated idiopathic thrombocytopenic purpura: a narrative review. Semin Thromb Hemost 2012 Jul; 38(5):463-8.
Annali di Stomatologia 2013; Suppl. 2: 1-48
31
Case Report
Oral submucosal hemorrhage as first clinical manifestation of H.Pylori-Associated Idiopathic Thrombocytopenic Purpura G. Mergoni, A. Sarraj, E. Merigo, P. Vescovi, M. Manfredi Oral Medicine, Pathology and Laser-assisted Surgery Unit, Dentistry Section, SBiBiT Department, University of Parma, Italy A 35-year-old man was referred for a diffuse bleeding of the oral cavity lasting for some days. Medical history was unremarkable and the patient was not taking any drugs. He did not report any pain, fever or fatigue. Petechiae on the surface of the soft palate, spontaneous gingival bleeding and hematoma on the left buccal mucosa was present at clinical examination. No head and neck lymphadenopathy was detected. Several blood test to exclude blood malignancies, coagulopathies or acute viral infections were prescribed. From the blood tests, very low platelets count (12500 plt/ml) was found. No other clinical or laboratory pathological findings were observed. The patient was then referred to the Onco-Hematological Department of the Azienda OspedalieroUniversitaria of Parma. With the working diagnosis of acute idiopathic thrombocytopenic purpura (ITP), other possible causes of trombocypenia, including leukemia, drugs, lupus erythematosus, cirrhosis, HIV, hepatitis C, congenital causes, and von Willebrand factor deficiency were progressively excluded. According to the recent evidence of a possible role of H. pylori in approximately half of the adults with ITP, the patient underwent the 13C-urea breath test, which resulted positive. The H. pylori infection was confirmed with a gastroscopy. The standard triple therapy (clarithromycin, amoxicillin, and a proton pump inhibitor) was maintained for 2 weeks in association with corticosteroids. The eradication of H. pylori infection was confirmed and a return to a normal platelets count was observed in a month along with the disappearing of the oral signs of hemorrhagic diathesis. H. pylori has a well demonstrated role in several gastroduodenal diseases and recently several studies have focused on its possible causal role in various extragastric disorders, including immune TP. The exact mechanisms of H. pylori-induced thrombocytopenia remains unknown, but platelet immunolysis secondary to molecular mimicry has been hypothesized. References • •
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial pathology Philadelphia: Saunders; 2002. Franchini M, et al. Helicobacter pylori-associated idiopathic thrombocytopenic purpura: a narrative review. Semin Thromb Hemost 2012 Jul; 38(5):463-8.
Annali di Stomatologia 2013; Suppl. 2: 1-48
31
