Peritoneal hemorrhage due to a ruptured ovarian cyst in ITP.
Immune thrombocytopenic purpura in children rarely causes severe bleeding. The incidence of intracranial hemorrhage is approximately 0.2% to 1.0%, and severe bleeding (defined as persistent epistaxis, melena, menorrhagia, gastrointestinal bleeding, etc, requiring hospitalization or transfusion) occurs in only 5% of patients. Epstein-Barr virus (EBV) associated idiopathic thrombocytopenic purpura (ITP) tends to behave similarly to non-EBV - associated ITP with no increase in hemorrhagic complications and only a small increase in time to remission. Immune thrombocytopenic purpura diagnosed in adolescence is more likely to be chronic then in childhood ITP, but has a higher rate of spontaneous resolution than in adults. However, females in this age group are in their early childbearing years and present a unique set of possible hemorrhagic complications not seen in younger patients. We present the case of an 18-year-old female with EBV-associated ITP, who developed a severe intra-abdominal bleed secondary to a hemorrhagic ovarian cyst.
Kaplan
Joel
J
Pennsylvania State University, Milton S. Hershey Medical Center, PO Box 850, Hershey, PA, USA.
Bannon
Christine C
CC
Hulse
Michael
M
Freiberg
Andrew
A
D000293:Adolescent; D020031:Epstein-Barr Virus Infections / Q000150:complications; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D010048:Ovarian Cysts / Q000150:complications* / Q000473:pathology*; D010537:Peritoneum / Q000473:pathology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012422:Rupture, Spontaneous / Q000150:complications; D014057:Tomography, X-Ray Computed
D016756:Immunoglobulins, Intravenous