Takuya Matsunaga, Mariko Watanabe, Kunihiko Ishitani
Older patients with immune thrombocytopenia are susceptible to infections and treatment-related adverse events, both of which can substantially worsen nutritional status. Although the Controlling Nutritional Status (CONUT) score and the Geriatric Nutritional Risk Index (GNRI) are widely used nutritional screening tools, evidence on their longitudinal changes during complex clinical courses remains limited. An 89-year-old man with vascular dementia was admitted to our hospital with severe thrombocytopenia and bleeding. After treatment with corticosteroids, intravenous immunoglobulin, and eltrombopag, his platelet count recovered. He subsequently developed pneumonia and was clinically diagnosed with probable Pneumocystis jirovecii pneumonia based on characteristic chest CT findings and an elevated serum β-D-glucan level, although microbiological confirmation was not obtained. After oral trimethoprim-sulfamethoxazole was initiated, he developed severe appetite loss; although this event was temporally associated with the medication, other contributing factors could not be excluded. His nutritional status consequently deteriorated for a prolonged period and required total parenteral nutrition. Longitudinal evaluation revealed divergent trends between the nutritional indicators. The CONUT score increased from 5 at baseline to 8 during the period of marked nutritional deterioration and subsequently improved to 5 as inflammation resolved. In contrast, the GNRI declined progressively from 81.3 at baseline to 77.4 and then to 72.8, without evidence of recovery, suggesting persistent chronic nutritional risk. This case indicates that, in older patients with dementia, improvement in laboratory-based nutritional indices does not necessarily reflect recovery from chronic malnutrition. Longitudinal evaluation combining the CONUT score and the GNRI may provide complementary information in complex clinical settings.