Thrombocytopenia beyond Cirrhosis-A Case of Helicobacter pylori associated ITP

Authors

Dr Jabin John Jacob , Dr Athulya G Asokan, Dr Tharesh Babu S R , Dr Akash Author

Keywords:

Immune thrombocytopenic purpura, Chronic liver disease, Helicobacter pylori, Hepatocellular carcinoma, Thrombocytopenia, Eradication therapy

Abstract

Thrombocytopenia is a frequent hematologic abnormality in patients with chronic
liver disease (CLD), commonly attributed to hypersplenism, portal hypertension, and
impaired thrombopoietin production. However, when thrombocytopenia presents
acutely or with bleeding manifestations, alternative etiologies must be considered.
We report the case of a 64-year-old male with alcohol-related CLD and newly
diagnosed hepatocellular carcinoma (HCC), who presented with profound
thrombocytopenia and mucocutaneous bleeding. Standard evaluations for hepatic,
infectious, and marrow-related causes were unremarkable. Subsequent identification
of Helicobacter pylori infection, coupled with a favorable response to eradication
therapy and corticosteroids, confirmed the diagnosis of H. pylori-associated immune
thrombocytopenic purpura (ITP). This case underscores the importance of a
systematic diagnostic approach to thrombocytopenia, particularly in the presence of
confounding comorbidities. It further highlights the potential role of H. pylori as a
modifiable trigger in secondary ITP and supports current recommendations for
routine screening in endemic regions.