On examination the boy looked well, and there was no enlargement of liver and spleen, and no enlargement of cervical lymph nodes. The boy had had a URTI three weeks earlier.
What is the diagnosis, management and differential diagnosis?
Diagnosis and management
The diagnosis is idiopathic thrombocytopenic purpura. Treatment is not always required. The disease is self-limiting and does not relapse. If severe bruising occurs, IV normal immunoglobulins can be used.
Possible different diagnosis
- Henoch-Schonlein purpura.
- Viral illnesses.
- Septicaemia, particularly meningococcal.
- Non-accidental injury.
- Affects children aged two to 10 years, boys more than girls.
- Symmetrical and non-itchy.
- Rash over extensor surface of limbs and buttocks.
- Initially maculopapular, then purpuric.
- Swelling of hands, feet and face.
- Arthralgia of joints, ankle or knee.
- Abdominal pain, vomiting and diarrhoea.
- Normal platelet count.
- Full recovery over a few months.