Biography:
Dr.Sana is currently working as a Doctor in Jinnah Hospital, Pakistan.
Abstract:
Background
Malaria is an endemic disease in Pakistan. P.vivax (Plasmodium vivax) is considered to cause a milder form of infection, while P.falciparum (Plasmodium falciparum )and mixed infections are associated with severe thrombocytopenia and cutaneous lesions. Here we report a rare presentation of isolated P.vivax malaria, causing severe thrombocytopenia and skin manifestations. To the best of our knowledge this is the first ever case reported from Pakistan of profound thrombocytopenia with isolated P.vivax infection.
Case Report
A 16-year old-female on treatment for idiopathic thrombocytopenic purpura (ITP) presented in emergency with complaints of epistaxis, gum bleeding and high grade fever for 3 days. Examination revealed fever (103° F), purpuric lesions on face, lips and petechial lesions on lower limbs (Fig1). Rest of the examination was unremarkable. There was no significant drug or family history. Labs showed Hb 11.2g/dl, TLC 7.3×109/l and platelet count 4×109/l. Peripheral smear revealed grossly reduced platelets with gametocytes of P.vivax (Fig.2). PT, APTT and INR were normal. Dengue, HIV and ANA serologies were negative. Chloroquine followed by primaquine was given along with tapering of prednisone. Fever and purpuric lesions settled. Platelet count showed an improving trend(Fig.3). Prednisone was stopped with regular follow ups. At 3 months her platelet count remained stable.
Discussion
Cases of isolated P.vivax malaria causing severe thrombocytopenia are rare. Above mentioned case is of P.vivax monoinfection causing severe thrombocytopenia and purpuric lesions. It Is pertinent to note that the patient was diagnosed and being treated for ITP before presenting to us. Hence physicians need to reevaluate the clinical spectrum of P. vivax presentation especially in the light of thrombocytopenia.
Conclusion
Isolated P.vivax infections can also cause severe thrombocytopenia along with bleeding manifestations. Therefore, it should not be missed in a differential diagnosis of severe thrombocytopenia especially in malaria endemic regions.