A 46-year-old woman presented with the following personal history: a) hypertension treated with Irbesartán 150 mg/day; and b) subclinical hypothyroidism, diagnosed after the incidental finding of elevated TSH.
The patient was diagnosed with chronic HCV liver disease, genotype 1b, with persistent elevation of transaminases.
After weighing the risks-benefits of the treatment, it was decided to start therapy with PEG IFN a-2b 100 mcg/week and ribavirin 800 mg/24 hours.
At the beginning of treatment he had a complete blood count, biochemistry and normal antibody tests.
At three months, the patient came to consultation due to weight loss of 8 kg, hypersalivation, tremors and asthenia.
If hyperthyroidism develops, treatment is suspended, TSH levels are determined 1.21 mNA, T3 4.21 mU/ml and T4 1.76 mNA
He was diagnosed with hyperthyroidism and started treatment with propranololol.
At four weeks the patient normalized TSH and thyroid hormones.
Thrombopyenia was monitored at the same time, with values of 109,000/ml at the time of withdrawal of the treatment and in spite of its withdrawal, it intensified until reaching 18,000/ml.
The patient is evaluated by the Hematology Department where it is performed: a) complete coagulation study, which was normal; b) smears: large platelets without morphological changes; and c) peripheral thrombocytopenia with bone marrow aspirate.
After reviewing all the results and the patient's history, she was diagnosed with idiopathic thrombocytopenic purpura secondary to treatment with PEG IFN.
After establishing a corticosteroid regimen, platelet counts remaining normal after steroid withdrawal were normalized.
