Autoimmune Cytopenias

There is growing recognition of an association between celiac disease (CD) and immune thrombocytopenia (ITP). The authors report the case of a 27-year-old man with primary ITP and a history of occasional nosebleeds and easy bruising, with 1 episode of rectal bleeding. He had high titers of CD-related antibodies (TTG-IGA, endomysial IGA), which remained elevated. Unsuccessful therapies included a gluten-free diet; several lines of treatment (steroids, intravenous immune globulin, rituximab, eltrombopag); and a nontraditional ITP treatment (azathioprine and plasma exchange).