Pictorial case study: Idiopathic thrombocytopenic purpura

The case: A seven-year-old boy presented to the surgery with his mother, with a widespread non-blanching rash, petechiae and bruises.

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.
  • Leukaemia.
  • Septicaemia, particularly meningococcal.
  • Non-accidental injury.

Differential diagnosis
Henoch-Schonlein purpura

  • 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.
  • Glomerulonephritis.
  • Normal platelet count.
  • Full recovery over a few months.

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