Thadchanamoorthy V, Dayasiri Kavinda
Faculty of Health Care Sciences, Eastern University, Chenkalady, Sri Lanka.
Base Hospital Mahaoya, Mahaoya, Sri Lanka.
Trop Med Health. 2020 Jul 20;48:59. doi: 10.1186/s41182-020-00248-1. eCollection 2020.
Dengue is a common mosquito-borne infection in tropical countries. Dengue incidence in Sri Lanka is generally showing a rising trend. Both chronic immune thrombocytopenia purpura (ITP) children and chronic ITP triggered by dengue fever in the pediatric age group are rarely reported. This unusual presentation is a diagnostic challenge to clinicians. The authors have reported a pediatric patient who presented with chronic ITP following recovery from dengue hemorrhagic fever.
A 14-year-old previously healthy boy was initially managed as for dengue hemorrhagic fever. Following initial detection of persistent thrombocytopenia at 2 weeks post-discharge, his parents defaulted follow-up for 1 year as he remained asymptomatic. However, 1 year after initial admission, the child re-presented with ecchymotic patches and a platelet count of 30 × 10/cumm. Review of serial blood counts performed during previous hospital admission and by his parents themselves revealed persistent thrombocytopenia over preceding 12 months. Subsequently, the child had an in-depth evaluation. The diagnosis of ITP was confirmed by ruling out differential diagnosis and he was managed as for chronic ITP. His platelet counts showed good response to oral corticosteroids and he is currently being followed up at the pediatric hematology clinic.
While reporting, a 14-year-old boy who developed chronic ITP following dengue hemorrhagic fever, this report highlights importance of frequent monitoring of blood counts to accurately detect and manage critical phase of dengue fever. The report also highlights the value of monitoring platelet counts in post-recovery phase to ensure they have normalized.
登革热是热带国家常见的蚊媒传染病。斯里兰卡的登革热发病率总体呈上升趋势。在儿童年龄组中，慢性免疫性血小板减少性紫癜（ITP）患儿以及由登革热引发的慢性ITP鲜有报道。这种不寻常的表现给临床医生带来了诊断挑战。作者报告了一名小儿患者，其在登革出血热康复后出现慢性ITP。
一名14岁既往健康的男孩最初按登革出血热进行治疗。出院后2周首次检测到持续性血小板减少，由于他无症状，其父母未进行1年的随访。然而，首次入院1年后，该患儿再次出现瘀斑，血小板计数为30×10/cumm。回顾其先前住院期间及家长自行进行的系列血常规检查发现，在之前的12个月里一直存在血小板减少。随后，该患儿接受了深入评估。通过排除鉴别诊断确诊为ITP，并按慢性ITP进行治疗。他的血小板计数对口服糖皮质激素反应良好，目前正在儿科血液科门诊接受随访。
在报告一名登革出血热后发生慢性ITP的14岁男孩时，本报告强调了频繁监测血常规以准确检测和管理登革热关键阶段的重要性。该报告还强调了在康复期监测血小板计数以确保其恢复正常的价值。
