The patient's review of systems was otherwise negative and she stated that she felt like she was in excellent health other than this current presentation of thrombocytopenia. On questioning dietary habits and history the patient reported that six-eight weeks prior to this presentation she was taking Plexus-SLIM® as a weight loss supplement. ![]() The patient’s medications were Apri® (desogestrel and ethynyl estradiol) and Metformin daily. ![]() Additionally, she stated that she had never had easy bruising or a confirmed episode of thrombocytopenia before. The patient denied any pertinent family and surgical history. The patient endorsed mild bleeding of the gums after brushing her teeth over the past three weeks as well as two episodes of epistaxis during this same time period. She was immediately sent for hospital evaluation and admission. After complete blood count (CBC) and comprehensive metabolic panel (CMP) were completed, the patient was subsequently found to have a platelet count of eight-thousand and mild transaminitis with alanine aminotransferase (ALT)/ aspartate aminotransferase (AST) of 99 and 63 respectively. Ī 30-year-old female, with a past medical history of polycystic ovarian syndrome and hypertension, presented to an internal medicine clinic for a chief complaint of “easy bruising” for approximately three weeks in duration. Plexus contains both garcinia cambogia fruit extract, and chromium polynicotinate, both compounds hypothesized to be a potential cause of thrombocytopenia. This supplement is a non-FDA approved drug marketed for weight loss and appetite suppression. Here we report a related instance of a proposed dietary cause of DITP caused by the use of a common weight loss supplement, Plexus®. Incidentally, it is also available in tonic water, a liquid drink commonly consumed. Most notable are the reports of quinine-induced thrombocytopenia, a compound derived from the Cinchona trees of Peru, used for the treatment of malaria and babesiosis. While being a relatively rare cause of ITP, dietary consumption of certain compounds is a well-reported precipitating event. Of specific interest to this report are the documented cases of secondary ITP induced by dietary compounds, categorized as drug-induced ITP (DITP). With studies estimating the incidence of the disease to be approximately eight per 100,000 in the United States, ITP is a relevant disease process that is routinely discovered and discussed in the hospital setting. ![]() Additionally, multiple mechanisms have been proposed for secondary ITP, defined by the destruction of platelets in the absence of primary autoimmune autoantibody production. The subsequent splenic destruction of autoantibody tagged platelets is accordingly the cause of the thrombocytopenia. Although the pathogenesis of the disease is not fully understood, it has been proposed that the pathogenic production of autoantibodies to the patient’s platelet membrane glycoproteins, specifically GPIIb/IIIa, is the primary pathologic feature of the disease. Primary immune thrombocytopenic purpura (ITP) is an autoimmune disease caused by autoantibodies directed against platelet antigens, characterized by thrombocytopenia and increased risk of bleeding.
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