Case Report: Immune Thrombocytopenia Purpura (Itp) - An Intra-Oral And Extra-Oral Presentation

A four year-old boy was referred to the Paediatric Dentistry Department by the Haematology Department at Our Lady’s Children’s Hospital Crumlin. He had a two week history of bleeding and crusting lips and intra-oral ulceration with a history of a cough two weeks prior to this. No relevant family history was noted. The child’s parents had initially presented him to community pharmacy and medical providers who advised attendance at the Emergency Department (ED) of the nearest tertiary care paediatric hospital. Upon presentation to the ED, he had a full blood count performed as part of his work up. Initial blood results revealed platelet count of 1. The rest of his blood results were essentially normal. On examination, extraoral facial, limb and trunk bruising were noted. Lips were crusted with blood and surrounded petechiae. Intraoral examination revealed soft palate petechiae, areas of ulceration/petechiae in the left and right buccal mucosa and a minor bleed from the lower left lateral primary incisor. The findings were consistent with a diagnosis of Immune Thrombocytopenia Purpura (ITP) precipitated by a viral infection. Initial treatment was with tranexamic acid for five days. On review, there was a marked improvement noted with only minimal blood crusting of the lower lip and fewer intraoral petechiae evident. No further treatment has been required to date. The child is being monitored by haematology and dental specialists with regard to signs, symptoms and progress. ITP is a haematological disorder defined by low platelet count. Children often develop this following a viral infection. Spontaneous bleeding or bleeding induced by trauma, may be the first clinical signs of ITP. This interesting case highlights a primary presentation of ITP with oral signs. This situation may present to a General Dental Practitioner or General Medical Practitioner in community or another Healthcare Professional and it is important to recognise the signs and symptoms and intervene appropriately