Idiopathic Thrombocytopenia Purpura

To the Editor .—We report a case of recurrent idiopathic thrombocytopenia purpura (ITP), in which removal of an accessory spleen increased the platelet count with a concomitant reduction in steroid requirements. Report of a Case .—A 25-year-old man was referred to the hospital with a platelet count of 12,000/cu mm that was noted prior to dental surgery. At age 9 years, ITP developed and he was treated with prednisone and splenectomy. He reports several subsequent episodes of epistaxis and petechial rashes. Examination showed an abdominal scar and petechiae on both legs. Admission laboratory studies were remarkable only for a platelet count of 6,000/cu mm. No Howell-Jolly bodies were seen on peripheral blood smear. Bone marrow aspirate showed increased megakaryocytes. Liver-spleen scan (Fig 1) revealed an accessory spleen. His course is shown in Fig 2. Initial improvement with prednisone was not maintained as the dose was