Secondary immune thrombocytopenic purpura: An unusual complication of scrub typhus

Abstract

Thrombocytopenia is a common manifestation of rickettsial disease. Immune thrombocytopenic purpura (ITP) is an acquired thrombocytopenia with antibodies detected against platelet surface antigens. It is the most common cause of acute-onset thrombocytopenia in an otherwise healthy child. ITP secondary to an underlying condition is a diagnosis of exclusion that is essential to establish treatment efficacy. Here, we report a case of immune thrombocytopenia secondary to scrub typhus infection, and we summarize its diagnosis and treatment. A 9-year-old boy was admitted to our hospital with hematuria, petechiae over both legs, and a history of fever for 11 days. Physical examination revealed the presence of an eschar over the left groin. Although thrombocytopenia is common in scrub typhus, failure of platelet counts to normalize even after medical management with doxycycline should prompt the clinician to consider other possibilities of thrombocytopenia, notably immune thrombocytopenia.

Keywords

• doxycycline
• immune thrombocytopenic purpura
• intravenous immune globulin
• scrub typhus