Immune thrombocytopenic purpura-related hemotympanum presenting with hearing loss.
A 5-year-old boy was admitted to our center with a major complaint of bilateral hearing loss for 2 days. He was diagnosed with acute immune thrombocytopenic purpura 3 months before the admission and treated with high-dose methylprednisolone 2 months ago. Physical examination revealed wet purpura in the oral mucosa, serous nasal discharge, multiple petechiae and ecchymosis of the lower lip. Otomicroscopic ear examination revealed the presence of bilateral hemotympanum. The patient denied head trauma, ear pain, fever, hypertension and medications, including salicylates. The patient received high-dose intravenous methylprednisolone because of low platelet count and wet purpura for 7 days and oral prophylactic amoxicillin-clavulanate for 14 days. The onset of the response to corticosteroids was rapid, and significant hematologic improvement was observed within a few days. The 2-week follow-up examination revealed intact tympanic membranes with normal color and mobility, and the patient restored normal hearing. In this patient, hemotympanum developed rapidly, and no predisposing cause other than immune thrombocytopenic purpura was found. However, presence of a serous nasal discharge may be a sign of viral upper respiratory tract infection. Therefore, it can be speculated that sneezing or coughing might have caused bilateral hemotympanum by increasing the middle ear pressure abruptly. We would like to emphasize that bleeding may occur in unusual sites and, unlike in healthy people, may cause bizarre symptoms in patients with bleeding diathesis. Hemotympanum can be considered among the indications to start treatment in patients with acute immune thrombocytopenic purpura.
Fisgin
Tunc
T
Department of Pediatric Hematology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey. fisgint@yahoo.com
Atmaca
Sinan
S
Duru
Feride
F
Ozyurek
Emel
E
Cetin
Recep
R
Albayrak
Davut
D
D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002675:Child, Preschool; D006312:Hearing Loss, Bilateral / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D014432:Tympanic Membrane / Q000473:pathology
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone