Jornal de relatos de casos clínicos

Ascorbic Acid - A Useful Adjuvant in Refractory Immune Thrombocytopenic Purpura: A Case Report

Abstract

Eindrini C Muhandiram*, Wasanthi Wickramasinghe, Inoshi Atukorala, Lallindra V Gooneratne

Immune Thrombocytopenic Purpura (ITP) is a heterogeneous disease with unpredictable treatment responses. This unpredictability is attributed in part to different pathogenic mechanisms including oxidative stress. The anti-oxidant effect of ascorbic acid in treatment of ITP has been described but evidence on its efficacy is contentious.

We describe a patient with refractory ITP in whom ascorbic acid was used as a useful adjuvant treatment. A 60-year old man with diabetes and hypertension presented with myocardial infarction and underwent primary coronary intervention. He had steroid dependent ITP, with a poor response to azathioprine, rituximab and splenectomy. He had drug induced cholestasis with dapsone. Therefore high doses of steroids were required to maintain safe platelet counts for antiplatelet drugs, which lead to poor glycemic control. High dose ascorbic acid was started, following which his platelet count remained above 100 x 109/L, permitting tailing off of prednisolone while continuing dual antiplatelet therapy.