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65 Dengue fever as a rare cause of immune thrombocytopenic purpura – a paediatric case report
  1. Nurul Ain Mohamed Ashrudin,
  2. Caroline Eng Siew Yin
  1. Malaysia


Background Immune thrombocytopenic purpura (ITP) typically presents with mucocutaneous bleeding and low platelet count. ITP is an autoimmune disorder characterised by autoantibody mediated immunologic destruction of normal platelets. It can be either primary or secondary due to other medical disorders. Most children have a history of preceding viral infection and tends to be self-limiting in nature. However, a minority have persistent thrombocytopenia that leads to chronic ITP.

Thrombocytopenia is a common laboratory finding in dengue fever. However, platelet count usually normalises during the recovery phase of dengue infection. Persistent thrombocytopenia requires further investigations and surveillance to ensure recovery. Here, we report a case of ITP following dengue infection responsive to corticosteroid treatment.

Objectives We aim to highlight the importance of surveillance of platelet count in Dengue infection to ensure normalcy. We also hope to create awareness of possibility of ITP when thrombocytopenia persists.

Methods A previously healthy 4 years old boy was admitted to our institution for Dengue fever, which was confirmed by a positive Dengue NS-1 Antigen testing and Dengue Immunoglobulin M (IgM). He was treated with intravenous fluid and serial monitoring of full blood count. His platelet count remained low at 1 to 8 × 109/L and failed to normalise by second week of infection. There was no history of bleeding tendencies, neither was there history of recurrent infection, joint pain, appetite and weight loss, consumption of traditional medications as well as significant family history of bleeding disorders or malignancy. The child was pink and anicteric. Lymph nodes were not enlarged and hepatosplenomegaly not present. Peripheral blood films confirmed thrombocytopenia. No blasts cells seen. Connective tissue disease screening was unremarkable. He was given a dose of intravenous immunoglobulin (IVIG) therapy. He remained asymptomatic and was then followed up as outpatient.

Results He presented two weeks after with petechiae and bruises after a minor fall. Upon arrival, his vital signs were stable. He had petechiae rashes and bruise over left forearm. Persistence of thrombocytopenia prompted for bone marrow aspiration and trephine biopsy (BMAT). The procedure yielded normocellular marrow with increased megakaryocytes, peripheral isolated thrombocytopenia compatible with peripheral platelet destruction. He was then started on corticosteroid. He showed initial good response to therapy. At the time of writing, his counts were monitored on outpatient basis.

Conclusions This case report highlights the importance of trending platelet count and ensure that they normalised after recovery phase of dengue fever. Persistent thrombocytopenia warrants further investigations to rule out secondary cause.

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