Conspicuous Response to Direct-Acting Antivirals in Chronic Hepatitis C-related Immune Thrombocytopenia: A Case Report

A 39-year-old man with a history of intravenous drug use was diagnosed to have a sudden onset of immune thrombocytopenia (ITP) in the background of a chronic hepatitis C infection with genotype 3a. Two courses of high-dose pulse dexamethasone therapy (40 mg daily for consecutive four days) failed to raise the platelet counts, but a combination direct-acting antiviral (DAA) regimen of sofosbuvir and velpatasvir, which had been proved to be effective for all hepatitis C virus (HCV) genotypes, successfully restored the platelets number to normal ranges after hepatitis C virus ribonucleic acid (RNA) was totally eliminated. Molecular mimicry of hepatitis C virus envelope proteins with platelet surface antigens is proposed to be the underlying cause of immune thrombocytopenia. An adequate direct-acting antiviral regimen is considered to be the most reliable therapy for hepatitis C-related immune thrombocytopenia.