A case report of refractory immune thrombocytopenia: Challenges in choice of therapies in resource limiting center

Introduction and importance: Refractory immune thrombocytopenic purpura (ITP) is a rare but serious condition causing significant morbidity and mortality due to inadequate response to standard treatments, resulting in persistent thrombocytopenia and increased bleeding risk.

Case presentation: An 18-year-old female patient, diagnosed with ITP two years prior following excessive vaginal bleeding and fatigue, was initially treated with oral prednisolone for two months and discharged in improved condition. Eighteen months after treatment cessation, she presented with recurrent excessive vaginal bleeding, intermittent bilateral nasal bleeding, skin rash, blurred vision, fatigue, tinnitus, vertigo, and intermittent headaches (one-month duration). Following a one-month admission during which she proved unresponsive to steroids, she received rituximab 500 mg IV weekly for four weeks, along with supportive care.

Clinical discussion: Refractory ITP in conjunction with COVID-19 is a rare and serious condition associated with significant morbidity and mortality, and a low survival rate. Effective, coordinated medical and surgical management, along with comprehensive rehabilitation from COVID-19, are crucial for improving outcomes in this severe condition.

Conclusion: Refractory ITP is a challenging and rare condition that can result in significant health complications, economic burdens, and a reduced quality of life for those affected.