Autoimmune Thrombocytopenic Purpura in a Patient with Renal Clear Cell Carcinoma

A case of renal clear cell carcinoma associated with autoimmune thrombocytopenic purpura is reported. A 56-year-old man presented as thrombocytopenia (10,000/microl) was diagnosed as idiopathic thrombocytopenic purpura after certain tests. He was started on large dose of steroid, intravenous gamma globulin, TPO and multiple platelet transfusion. Platelet count was not stable. Then computerized tomography revealed a left renal tumor 46×25×31mm³. Based on the diagnosis of left renal neoplasm, left nephrectomy with preoperative high-dose intravenous gamma globulin and platelet transfusion was performed. Pathological examination revealed clear cell carcinoma. After the operation, the platelet count increased gradually. But the tumor metastasized 4 months later. Therefore, we consider that extensive tests shall be run to exclude cancer before confirming diagnosis of ITP, the elder patients, or the patients with poor therapeutic efficacy or cortisone dependent. We do not recommend using Cs as the treatment for Cancer-related ITP-like Syndrome. The tumor should be controlled first as soon as possible. If the cancer is localized, IVIG and platelet transfusion can be an appropriate initial treatment for upgrading platelet counts quickly to win time for surgery.