10 October 2021
: Case report 
Treatment-Refractory, Primary Immune Thrombocytopenic Purpura in a Patient with Celiac Disease
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Beka Aroshidze1ABCDEFG*, Sos Nalghranyan2ABCDEFG, Gregory Gotlieb2CDF, Burak Erdinc1ABCDEFG, Alok Aggarwal3ABCDEFG, Cherif El Younis4ABCDEF, Boris Avezbakiyav2ABCDEFGDOI: 10.12659/AJCR.931877
Am J Case Rep 2021; 22:e931877
Table 1. Timeline showing therapeutic intervention, along with respective platelet counts and celiac disease-specific antibody panel.
| Timeline | Treatment | Platelet count | Celiac antibody panel Ref. range tTG-IgA: <4 U/mL Endomysial IgA: Negative (<1: 5) |
|---|---|---|---|
| 1/15/20 | Treatment naïve | 4×10/uL | |
| 1/17/20 | Steroid, IVIG, platelet transfusion | 15×10/uL | |
| 2/21/20 | Steroid, rituximab, IVIG | 3×10/uL | tTG-IgA: >100 U/mL Endomysial IgA: Positive (1: 80) |
| 5/5/20 | Eltrombopag | 4×10/uL | |
| 5/27/20 | Azathioprine & eltrombopag | 7×10/uL | |
| 6/10/20 | Plasmapheresis & maintenance treatment with eltrombopag | 7×10/uL | tTG-IgA: 36 U/mL Endomysial IgA: Positive (1: 10) |
| 7/1/20 | Splenectomy | 141×10/uL | |
| 11/30/20 | Status post splenectomy followed by fostamatinib maintenance | 29×10/uL | tTG-IgA: 36 U/mL Endomysial IgA: Positive (1: 10) |