A Patient With Persistent Immune Thrombocytopenic Purpura Associated With Helicobacter Pylori Infection And Esophageal Candidiasis Following Long-Term Corticosteroid Therapy

Abstract

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia and has been associated with Helicobacter pylori (H. pylori) infection. Long-term corticosteroid therapy, the mainstay of ITP treatment, may cause infectious complications. Case: We report a 23-year-old woman with persistent, steroid-refractory ITP who presented with fatigue and multiple ecchymoses without overt bleeding or signs of infection. Initial evaluation showed severe thrombocytopenia, pancytopenia, and high immature platelet fraction, with no evidence of autoimmune disease, viral hepatitis, or HIV. During hospitalization, she required repeated transfusions and high-dose methylprednisolone, yet platelet counts remained low. Further work-up revealed positive anti-H. pylori IgM and biopsy-proven H. pylori gastritis. Esophagogastroduodenoscopy also demonstrated extensive esophageal candidiasis, likely related to prolonged corticosteroid and immunosuppressive exposure. Triple therapy for H. pylori and systemic plus topical antifungals were initiated. The clinical course was complicated by hospital-acquired pneumonia with Pseudomonas aeruginosa and Klebsiella pneumoniae bacteremia, leading to sepsis, respiratory failure, transfer to intensive care, and death. Conclusion: This case illustrates the complex interaction between H. pylori–associated ITP and long-term steroid toxicity, underscoring the need for H. pylori screening, eradication therapy, and vigilant monitoring for opportunistic infections in patients with chronic or refractory ITP. Careful risk–benefit assessment of immunosuppression remains essential.