Case Report:
We present the case of a 15-year-old girl with no significant medical
history who was admitted to the hospital for 2 weeks with chief
complaints of shortness of breath, right-sided chest pain, and sudden
dizziness. She mentioned of heavy menstrual loss a day prior to the
onset of these symptoms. The patient denied recent sick contacts,
travel, or taking medications. On physical examination, she had
anicteric sclera, severe conjunctival pallor, normoactive bowel sounds,
and a non-tender, non-distended abdomen without hepatosplenomegaly. She
was afebrile (38.6 °C), her blood pressure was 80/46 mmHg, her heart
rate was 120 beats per minute (bpm), and her respiratory rate was 32
breaths per minute (bpm). The physician suggested the patient get some
clinical laboratory tests done and transfused a unit of blood the same
day. Investigations showed microcytic hypochromic anemia (possibly due
to iron deficiency) with thrombocytopenia in PBF, serum ferritin5.16
ng/ml hemoglobin 7.3 g/dl, ESR 85 mm/1st hr, platelet counts
15000/cu.mm. , RBC count 3.03 million/cu.mm with HCT/PCV 24%,
HBsAg(ICT) negative, HIV 1&2 negative. The patient then gets
conservatively managed with 2 units of blood transfusion, tab.
prednisolone, Cap. ferrous sulfate + zinc + folic acid, and various
symptomatic medical treatments. Her anemia gradually improved and she
was discharged after 8 days when her hemoglobin and ESR reached 12.0
g/dl and 15 mm/1st hr, respectively, with a suggestion of regular
follow-up.
After eight weeks, the patient experienced the similar symptoms as
earlier following heavy menstrual blood loss, and was brought to the
hospital. This time, she came up with vesicular skin a rash across her
face, neck, and chest, which she had developed two days before
admission. Figure 1. Initial laboratory workup showed 5.6 grams/dl
hemoglobin, ESR 72 mm/1st hr, with RBC count 2.11 million/cu.mm, HCT/PCV
87%, Total platelet count 47000/cu.mm, and mild leukocytosis, PBF, and
bone marrow study illustrated Immune Thrombocytopenic purpura (ITP),
ultrasound report of the whole abdomen reveals normal, HBsAg negative,
immunological reports (ANA & anti ds DNA), CT report and biochemical
study of blood displayed normally. Table 1. Clinically, she was
diagnosed with chicken pox and treated with acyclovir, paracetamol,
antihistamines, hydration, folic acid +zin, and three units of blood
transfusion for severe anemia. Gradually, the patient’s condition
improved anemia, symptoms of chickenpox disappeared, and other
parameters returned to normal, and she was allowed to go home after 19
days with the advice of regular follow-up.