www.kjurology.org http://dx.doi.org/10.4111/kju.2012.53.7.502 Case Report Bilateral Ureteral Stones and Spontaneous Perirenal Hematoma in a Patient with Chronic Idiopathic Thrombocytopenic Purpura Mehmet Akyüz, Selahattin Çalışkan, Cevdet Kaya Clinic of Urology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast com- puted tomography scan of a 57-year-old male patient who developed macroscopic hema- turia during his treatment in the clinics of internal medicine because of left flank pain and diffuse petechial rashes all over his body. The patient, who had been receiving 3 chronic ITP treatment for 1 year, had a very low platelet count (4,000/mm ). The patient was prescribed bed rest, and his platelet count increased to a safe level for surgical inter- vention of above 50,000/mm3 with administration of prednisolone, intravenous im- mune globulin, and platelet suspension. A stone-free state was achieved after bilateral ureterorenoscopy and pneumatic lithotripsy. A conservative approach was followed for the perirenal hematoma. Upon regression of the perirenal hematoma, the patient was discharged at 9 weeks postoperatively. Key Words: Idiopathic; Purpura; Renal hematoma; Thrombocytopenic; Ureteral calculi This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Article History: received 13 April, 2011 accepted 1 September, 2011 Corresponding Author: Mehmet Akyüz Clinic of Urology, Haydarpaşa Numune Training and Research Hospital, Üsküdar, İstanbul 34718, Turkey TEL: +90-532-6688200 FAX: +90-216-3455982 E-mail: hmakyuz@yahoo.com Chronic idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease that is characterized by isolated thrombocytopenia resulting from degradation of autoanti- body-coated platelets in the reticuloendothelial system. Diagnosis of this disease, which responds favorably to con- ventional therapy, is not challenging, and the disease usu- ally has a benign clinical course. Bleeding-related symp- toms consist of mild mucocutaneous bleeding such as pur- pura, gingival bleeding, and nosebleeds. Hematuria and gastrointestinal and intracranial bleeding are rarely seen hemorrhagic episodes that lead to more serious clinical manifestations [1-3]. Perirenal hematoma develops in as- sociation with spontaneous or traumatic vascular abnor- malities and hemorrhagic diathesis and occasionally leads to a life-threatening clinical picture requiring urgent sur- gical intervention [2-7]. In this case report, we present for the first time the management of bilateral perirenal hema- toma and distal ureteral stones that developed sponta- neously in a patient undergoing treatment of ITP. We also Korean Journal of Urology Ⓒ The Korean Urological Association, 2012 evaluate the case in light of the literature. CASE REPORT A 57-year-old patient with a diagnosis of chronic ITP for 1 year was referred to our emergency department with com- plaints of left flank pain and diffuse petechial bleeding all over his body. A complete blood count revealed thrombocy- 3 topenia (4,000/mm ), which led to his admission into the clinics of internal medicine. On the third day of chronic ITP therapy, the patient developed macroscopic hematuria, and we consulted with the patient after the urinary system ultrasound revealed bilateral perirenal hematoma. We learned from his medical history that he had not previously had any complaints of gross hematuria. He had previously undergone extracorporeal shock wave lithotripsy (ESWL) because of a left ureteral distal stone. His general health state was good and his vital findings were stable. The phys- ical examination revealed a relaxed abdominal region with 502 Korean J Urol 2012;53:502-504