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Acquired platelet dysfunction with eosinophilia mimicks non-accidental injury: a case report

Anuar, Muhamad Azamin and A. Talib, Norlelawati and Misaridin, Nur Farah Izzati and Mohamed, Mossad Abdelhak Shaban and Hasan, Taufiq Hidayat (2019) Acquired platelet dysfunction with eosinophilia mimicks non-accidental injury: a case report. In: 15th Asian Oceanian Congress of Child Neurology in conjunction with the 41st Malaysian Paediatric Association Annual Congress 2019 “Synergy to Challenge Boundaries in Child Neurology”, 19th-22nd September 2019, Kuala Lumpur. (Unpublished)

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Abstract

APDE is an acquired, transient bleeding disorder characterised by normal platelet counts with marked eosinophilia. It was previously known as ‘nonthrombocytopenic purpura with eosinophilia’. We report a case of a 3-year-old boy with prolonged history of spontaneous unexplained bruising which was initially investigated by Suspected Child Abuse and Neglect (SCAN) team for suspected non-accidental injury (NAI). Case summary: A 3-year-old boy attended the paediatric clinic with a 4-month history of recurrent spontaneous bruising. Parents were unsure of preceded illness, but he remained well with no history of trauma. His past medical history was unremarkable and father is a thalassaemia carrier. Upon assessment in clinic, he was subsequently referred for suspected NAI and an assessment by the SCAN team led to a police report with a plan to review in 2-months. Parents later decided to bring the child for further medical assessments which revealed multiple bruises over both thighs, back of shoulder, loin and trunk with varying sizes and ages. They were all non-tender on palpation with no recognisable shapes or patterns. Blood results showed normal liver functions with slightly prolonged APTT 39.8 secs. He has normal platelet count with significant eosinophilia 2.2 x 10^9/L (approximately 15%) and occasional reactive lymphocytes. Reflecting this result, plan for platelet functions and von Willebrand tests were made. However, due to costs, we decided to treat the child with anti-helminthic agent for possible parasitic infestation. He had 3 days course of albendazole and no further bruises appeared after 5 days of completing treatment. Discussion: Unexplained bruises are significant in children in view of possible sinister causes. Idiopathic thrombocytopenic purpura (ITP) remains the most common cause of acquired bleeding disorder in children and the diagnosis is usually straightforward based on cardinal clinical and laboratorial characteristics. The clinical presentation of APDE can mimic ITP in many ways yet normal platelet counts often leads to a delay in diagnosis. Reassuringly, the course of APDE is benign and no treatment is often required. Investigations however are costly, therefore treatment with anti-helminthic agent would be an alternative option in providing assurance to family and medical practitioners dealing with suspected cases.

Item Type: Conference or Workshop Item (Poster)
Additional Information: 8392/75191
Uncontrolled Keywords: "spontaneous bruising", "unexplained bruising", "nonthrombocytopenic purpura", "physical abuse", "non-accidental injury", "platelet dysfunction"
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Medicine
Kulliyyah of Medicine > Department of Paediatrics
Kulliyyah of Medicine > Department of Pathology & Lab Medicine
Depositing User: Dr Muhamad Azamin Anuar
Date Deposited: 12 Dec 2019 09:56
Last Modified: 26 Feb 2020 15:03
URI: http://irep.iium.edu.my/id/eprint/75191

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