Varicella-associated immune thrombocytopenic purpura in a child with bleeding manifestations with review of literature

Abstract

Chickenpox is a benign and self-limiting viral exanthematous infection, but sometimes it may be associated with complications. Mild thrombocytopenia occurs in 1-2% of children with varicella, but severe immune-mediated thrombocytopenia associated with bleeding is a rare complication. Various other mechanisms for thrombocytopenia have been implicated-decreased bone marrow production of platelets, disseminated intravascular coagulation, virally-induced platelet aggregation followed by phagocytosis or lysis, direct viral invasion of platelet precursors and viral-derived neuraminidase causing enzymatic desialylation of platelets followed by removal of abnormal platelets by reticuloendothelial system. We report a case of severe thrombocytopenia, possibly immune-mediated with bleeding in the form of petechiae and epistaxis in a child recovering from chickenpox, who is successfully treated with steroids. This may at least in part guide clinicians to recognize this rare but potentially dangerous complication of chickenpox.

Parallel pathogens: Coexistence of chickenpox and idiopathic thrombocytopenic purpura—A case report

“…One of the hematological complications reported is ITP 8 . Several studies have shown the association between chickenpox and ITP in both children and adults 1,9 . In this case, we presented a rare occurrence of simultaneous chickenpox and ITP.…”

“…8 Several studies have shown the association between chickenpox and ITP in both children and adults. 1,9 In this case, we presented a rare occurrence of simultaneous chickenpox and ITP. In review of literature, we found a single case reported with a similar case scenario where a 11-year-old boy presented with hemorrhagic vesicular rashes, petechiae, ecchymosis, epistaxis, hematuria and melena, dated back in 1947.…”

“…Chickenpox is commonly linked to mild thrombocytopenia in children, but severe thrombocytopenia resulting in bleeding is uncommon. 1 Immune Thrombocytopenia treatments, blood transfusions, and supportive care were used in the course of treatment, leading to full recovery. This case emphasizes the importance of prompt diagnosis, appropriate management, and regular follow-up for patients with both chickenpox and ITP.…”

“…Varicella‐zoster virus (VZV) causes a harmless viral rash known as chickenpox, which typically does not require treatment but it can occasionally lead to complications. Chickenpox is commonly linked to mild thrombocytopenia in children, but severe thrombocytopenia resulting in bleeding is uncommon 1 . Immune Thrombocytopenia (ITP) is a blood disorder in which platelets are destroyed through immune‐mediated mechanisms, resulting in low platelets number which is characterized by a platelet count that is less than 100 × 109/L 2 .…”

“…Chickenpox is commonly linked to mild thrombocytopenia in children, but severe thrombocytopenia resulting in bleeding is uncommon. 1 Immune Thrombocytopenia (ITP) is a blood disorder in which platelets are destroyed through immune‐mediated mechanisms, resulting in low platelets number which is characterized by a platelet count that is less than 100 × 109/L. 2 ITP is frequently triggered by viral infections and/or live virus vaccinations.…”