Combination therapy of steroids and immunoglobulin in chronic refractory idiopathic thrombocytopenic purpura (ITP) enabling renal stone fragmentation by lithotripsy.

A 27-year-old woman with idiopathic thrombocytopenic purpura (ITP), which had relapsed following splenectomy, was found to be refractory to a wide range of individual immunosuppressive agents. However, a normal platelet count was achieved with high-dose dexamethasone followed by intravenous immunoglobulins (i.v. Ig). Either agent used alone had previously produced clinically inadequate platelet increments. With this regime, successful renal stone fragmentation by lithotripsy was undertaken, which required no blood product support over the peri-operative period. It is suggested that patients with refractory ITP requiring major procedures, who have not responded to i.v. Ig treatment, merit a repeat trial following high-dose steroid.