Idiopathic thrombocytopenic purpura treated with steroid therapy does not prevent acute myocardial infarction: a case report

We report the case of a 65-year-old man affected by idiopathic thrombocytop enic purpura, who developed an acute myocardial infarction after 2 years of steroid therapy. Thrombocytopenia was initially recognized II years earlie r, and became severe during the past 2 years [platelets (PLTS) 10000-30000/ mu l]. He was treated with steroids, initially to perform a surgical proced ure (prednisone 75 mg/day), subsequently to maintain a platelet count of ab out 50000/mu l (prednisone 12.5 mg/day). After 1 year of treatment, he bega n to complain about exertional angina and dyspnea. His blood pressure becam e elevated and cholesterol level raised. The exercise electrocardiogram, pr eviously manifesting ischaemic changes, normalized after 1 month of steroid wash-out; however, steroid therapy was reinstituted (prednisone 5 mg per d ay). One year later, he suffered an infero-lateral non-Q-wave myocardial in farction. It seems likely that the severe coronary atherosclerosis present in our patient developed despite a low platelet count, under the spur of a heavier risk factor profile. Steroid therapy could have had a role as a pre cipitating agent of the acute event, and the opportunity of alternative tre atments is considered. (C) 1999 Lippincott Williams & Wilkins.