Early diagnosis and tailored treatment in atypical idiopathic thrombocytopenic purpura: A CARE compliant case report.

RATIONALE

Idiopathic thrombocytopenic purpura (ITP) is a hematological disorder characterized by a decrease in platelet count due to increased destruction or decreased production. Although the pathophysiology and etiology remain largely unknown, understanding the typical and atypical presentations of ITP is crucial for early diagnosis and effective management. This case report highlights the rationale behind a comprehensive approach for the diagnosis and treatment of ITP, especially in cases with atypical presentations.

PATIENT CONCERNS

A 45-year-old woman presented with a mucocutaneous petechial rash spreading over the ocular and oral areas of the face, accompanied by similar manifestations in the limbs. While petechiae are a hallmark of ITP, the initial widespread distribution and specific involvement of these extensive mucocutaneous areas were considered atypical presentation patterns in this case. She also reported moderate gum bleeding, epistaxis, and spontaneous ecchymosis of the oral mucosa. These symptoms suggested a potential platelet disorder.

DIAGNOSES

Based on the clinical presentation and laboratory findings, the diagnosis of ITP was made. The patient's symptoms and laboratory results were consistent with the typical features of ITP, including a decreased platelet count, petechiae, and manifestations of bleeding.

INTERVENTIONS

A thorough history and physical examination were conducted to rule out other potential causes of thrombocytopenia, including infections, medications, and underlying autoimmune diseases. Laboratory tests, including complete blood count, peripheral blood smear, and coagulation profile, were performed to assess platelet count, morphology, and clotting function. The diagnosis was initially followed by conservative management. Later on, the patient was also treated with corticosteroids and then intravenous immunoglobulin.

OUTCOMES

The patient responded well to intravenous immunoglobulin, thereby demonstrating the effectiveness of the treatment. She was then discharged with maintenance doses of corticosteroids and a close follow-up schedule.

LESSONS

This case report illustrates the importance of recognizing the diverse presentations of ITP, including its atypical manifestations. Early diagnosis and effective management are crucial for improving patient outcomes. A comprehensive approach, including thorough history, physical examination, and laboratory tests, is essential for the accurate diagnosis and effective treatment of ITP.