Introduction:
Varicella-zoster virus (VZV) is the causative agent of chickenpox, a
viral rash that is generally benign and self-limiting, requiring minimal
treatment. However, in rare cases, complications can arise. Although
chickenpox is commonly associated with mild thrombocytopenia in
children, severe thrombocytopenia resulting in bleeding is uncommon
[1]. Immune Thrombocytopenia (ITP) is a blood disorder characterized
by the destruction of platelets through immune-mediated mechanisms,
leading to a decrease in platelet count below 100×10^9/L. Viral
infections and live virus vaccinations are frequent triggers of ITP. It
presents as acute, self-limiting episodes of bleeding, usually minor,
but with the potential for intracranial hemorrhage (ICH). Compared to
other causes of thrombocytopenia, ITP typically results in less severe
bleeding. Diagnosis is based on clinical presentation and laboratory
findings, and it is a diagnosis of exclusion [2]. The primary goal
of treating a patient with ITP is to raise their platelet count to a
safer level, reducing the risk of severe bleeding, particularly
intracranial hemorrhage (ICH). Corticosteroids have been effectively
used since the 1950s, reducing the production of anti-platelet
antibodies and enhancing the clearance of opsonized platelets.
Intravenous immunoglobulin (IVIG), introduced by Imbach et al., has also
shown high efficacy in increasing platelet counts in over 80% of
patients, with a faster onset of action compared to steroids [3].
The coexistence of chickenpox and ITP presents a clinical conundrum, as
the underlying mechanisms linking these conditions remain elusive.
Although there are sporadic reports in the medical literature of
patients developing ITP following chickenpox, the incidence of this
simultaneous presentation is exceedingly rare. Furthermore, the majority
of these reported cases lack comprehensive hematologic data, hindering a
thorough understanding of the clinical course and management strategies.
We thus present one such intriguing and rare case of chickenpox with
simultaneous ITP purpura.