Immune Thrombocytopenic Purpura: A Case of Risperidone-Induced Immune THrombocytopenia Purpura
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
American Journal of Respiratory and Critical Care Medicine
Abstract
Immune Thrombocytopenic Purpure (ITP) is defined as an autoimmune disorder, which is characterized by an isolated low platelet count. ITP clinically manifests as mucocutaneous bleeding and widespread petechia and purpura. ITP most commonly occurs between ages 18 and 40 and is more common in women. Management includes initiation of steroids, immunoglobulins, and possibly splenectomy. Primary ITP is classified as ITP without an underlying cause, while secondary ITP identifies an underlying factor that contributes. While many secondary causes of ITP exist, we present a case of drug induced ITP due to risperidone. A 49-year-old female presented with worsening rash, epistaxis, gingival bruising, and fatigue over several weeks. She notably recently started risperidone and denied any further medication changes. Initial lab findings indicated thrombocytopenia, with a platelet count of 0. Comprehensive workup was significant for a positive anti-nuclear antibody (ANA) and anti-SSA (anti-ro) antibody, with negative HIV, hepatitis C, haptoglobin, LDH, TSH, D-dimer, infectious mononucleosis, anti-cardiolipin antibodies, beta 2 glycoprotein, and complement levels. All imaging, include CT scans of the chest, abdomen, and pelvis were unremarkable. The patient's risepridone was stopped and she was treated with intravenous immunoglobulin, high dose steroids followed by a steroid taper, and prophylactic trimethoprim-sulfamethoxazole while on steroids, with resolution of her platelet count back to normal. While antipsychotics are known to have hematologic adverse events, amongst the antipsychotics, risperidone is considered to have a low risk of hematotoxicity. Additionally, while this patient’s labs were positive for ANA and anti-SSA, she did not have clinical stigmata of Lupus or Sjogren’s Syndrome, and the hematologic profile of these conditions do not include thrombocytopenia as severe as described according to literature. This case illustrates an uncommon presentation of drug induced immune thrombocytopenia due to risperidone, alongside a newly founded positive ANA and positive anti-SSA.
Volume
211
First Page
A5543
Last Page
A5543
Recommended Citation
Al-Nabolsi A, Tripathi V, Darany G, Khan O. Immune thrombocytopenic purpura: a case of risperidone-induced immune thrombocytopenic purpura. Am J Respir Crit Care Med. 2025 May;211:A5543. doi:10.1164/ajrccm.2025.211.Abstracts.A5543
DOI
10.1164/ajrccm.2025.211.Abstracts.A5543
Comments
American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA