A 47-year-old woman was admitted to our hospital complaining of subcutaneous
hemorrhages. She had taken medicine because of a
common cold one month before admission, and two weeks after that, she noticed the
hemorrhagic diathesis. Laboratory data on admission were as follows; 1,000/microliters of platelet count (PLT), normal myelogram, normal coagulation tests, positive PAIgG and anti-platelet antibody. She was diagnosed as
idiopathic thrombocytopenic purpura and a standard dose of
prednisolone was started immediately. However, on the 3rd hospital day (HD), frequent
hematemesis from submucosal
hematomas developed. Pulse
therapy of
methylprednisolone and immunoglobulin therapy were ineffective. From the 15th HD slow
drip infusion of
vincristine and continuous
drip infusion of 1, 500 mg/day of
gabexate mesilate (GM) were started. Because PLT increased to 85,000/microliters and
hematemesis disappeared on the 22nd HD, GM was discontinued. However on the 25th HD, PLT decreased to 1,000/microliters again. After re-starting GM, PLT was maintained at over 100,000/microliters. Subsequent examinations ruled out
collagen diseases but revealed that she had Hashimoto's
thyroiditis. We concluded that the
complement inhibitory action of
gabexate mesilate might have contributed to PLT increase in this case, as has been previously reported in three other cases.