Exacerbation of chronic idiopathic thrombocytopenic purpura following reactivation of an occult hepatitis B

Immune thrombocytopenia is a disease mediated by platelet autoantibodies that accelerate platelet destruction and inhibit their production. Most cases are considered idiopathic, whereas others are secondary to coexisting conditions such as infectious diseases. All hepatotropic viruses seem able to cause thrombocytopenia. The advent of molecular techniques has revealed the possible persistence of hepatitis B virus genome in HBsAg-negative individuals with or without serologic markers of previous infection. This form of infection is named occult. We report a case of autoimmune thrombocytopenia associated with acute reverse seroconversion of hepatitis B in a patient who was initially hepatitis B virus surface antigen negative and hepatitis B virus surface antibody positive. The search for occult HBV infection before immunosuppressive therapy and monitoring for reactivation is today diagnostic standard and several reports have been presented in literature about HBV reactivation following immunosuppressive therapy. In our patient, reactivation of dormant HBV happened prior to any immunosuppressive therapy. The case we report offers the occasion to emphasize the importance of medium-term and long-term hemovigilance also in other kind of patients than in subjects on immunosuppressive therapy. A deeper follow-up is advisable even in patients showing an unexplainable worsening of their hematological conditions.