Idiopathic thrombocytopenic purpura in the older adult patient.

Forty adults with idiopathic thrombocytopenic purpura (ITP), aged over 45 years, were seen from March 1954 to December 1983 at the Medical College of Georgia. All patients had bleeding manifestations at presentation. Twenty-one of 40 (52.5%) during the follow-up period had either life-threatening or fatal bleeding episodes. There were no significant differences for the presence of any presenting clinical or laboratory feature for patients who achieved a complete remission compared with those who did not. A complete response to therapy, younger age, higher presenting hemoglobin level, and absence of central nervous system bleeding favorably influenced overall survival. Therapy was ineffective in this age group, with only 12 patients (30%) achieving a permanent complete remission. Fourteen patients (35%) died either from bleeding or from direct complications of therapy. This analysis of ITP in the older adult suggests a disease refractory to therapy that is associated with major morbidity and mortality.

Idiopathic thrombocytopenic purpura in adults.

Idiopathic thrombocytopenic purpura (ITP) is a primary immune thrombocytopenia that is typically manifested in adults by acute bleeding, severe thrombocytopenia, and normal to increased megakaryocytes in the bone marrow. Labeling studies suggest that most patients with ITP have an IgG antibody directed against the platelet membrane resulting in sequestration in the spleen, and that sequestration in other organs such as the liver bodes a poor prognosis. Splenectomy and/or corticosteroids remain the mainstay of therapy, with permanent remissions induced in 75% of patients. We review alternative forms of therapy such as immunosuppressive agents, high-dose gamma-globulin, and others to enable the practicing physician to select the best treatment for patients refractory to standard therapy. Age appears to influence response to therapy and morbidity, with advancing age imparting a poorer prognosis.

Cefoxitin therapy for Mycobacterium fortuitum bacteremia with associated granulomatous hepatitis.

Mycobacterium fortuitum bacteremia with granulomatous hepatitis complicating home cyclic parenteral nutrition through an indwelling Broviac catheter occurred in a 41-year-old woman. She was successfully treated with intravenous cefoxitin and removal of the indwelling central catheter. The granulomatous hepatitis occurred in the apparent absence of mycobacteria from the liver. Incorrect identification of the organism as Corynebacterium J-K led to a change of antimicrobial therapy and clinical deterioration. It is recommended that acid-fast stains be done on "diphtheroids" when such isolates are suspected pathogens.