IDIOPATHIC THROMBOCYTOPENIC PURPURA IN A LIVER-TRANSPLANT RECIPIENT WITH PREVIOUS PRIMARY BILIARY-CIRRHOSIS

The loss of immunotolerance has been implicated in the pathogenesis of both primary biliary cirrhosis (PBC) and idiopathic, immune-mediated thrombocytopenic purpura (ITP). An association between these two autoi mmune diseases has been well described. We describe a 41-year-old woma n in whom ITP developed 457 days after liver transplantation for PBC w hile receiving immunosuppressive medications sufficient to maintain al lograft function. Our case report, the first to describe post-transpla nt ITP in association with PBC, demonstrates the persistence of the un derlying immune dysregulation of PBC after transplantation. The practi ce of decreasing the dosage of immunosuppressive medication to mainten ance levels after transplantation may unmask the effects of this defec t in inmunotolerance.