American Journal of Internal Medicine

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Isolated Thrombocytopenia as an Initial Presentation of Systemic Lupus Erythematosus: A Case Report of a 17 Year Old Female

Received: 14 May 2023    Accepted: 27 May 2023    Published: 6 June 2023
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Abstract

Background: Childhood systemic lupus erythematosus (SLE) can manifest in various ways, with hematologic abnormalities being common. However, isolated thrombocytopenia is relatively infrequent. Case Presentation: In this case report, we describe a 17-year-old female patient who presented with complaints of generalized body aches, weakness, anorexia, and recent epistaxis, with no relevant medical history, medication use, smoking, or bleeding disorder in the family. After excluding infectious and other autoimmune causes, SLE was the final diagnosis due to high ANA and anti-dsDNA titers. Despite conventional steroid therapy, the patient's platelet count remained low, prompting the increase of prednisolone up to 2mg/kg/day. By day 7th, the platelet numbers reached to 85000/μl, indicating a favorable response. Conclusion: Our findings suggest that when isolated thrombocytopenia does not respond to conventional steroid therapy, SLE should be considered, and that a child presenting with isolated hematological abnormality should be screened for childhood-onset SLE.

DOI 10.11648/j.ajim.20231103.16
Published in American Journal of Internal Medicine (Volume 11, Issue 3, May 2023)
Page(s) 60-63
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Isolated Thrombocytopenia, 17 Years Old Female, Initial Presentation of SLE, ANA, Anti dsDNA, A Case Report

References
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[3] Lahita RG. The role of sex hormones in systemic lupus erythematosus. Curr Opin Rheumatol 1999; 11: 352-6.
[4] McNeil HP, Chesterman CN, Krilis SA. Immunology and clinical importance of antiphospholipid antibodies. Adv Immunol 1991; 49: 193-280.
[5] Sandoval C, Visintainer P, Ozkaynak MF, Tugal O, Jayabose S. Clinical features and treatment outcomes of 79 infants with immune thrombocytopenic purpura. Pediatr Blood Cancer. 2004; 42 (1): 109-12. https://doi.org/10.1002/pbc.10458, PMid: 14752803.
[6] Jung JY, Rum OA, MD, Kim JK, Park M. Clinical course and prognostic factors of childhood immune thrombocytopenia: Single center experience of 10 years. Korean J Pediatr.
[7] Audia S, Mahevas M, Samson M, Godeau B, Bonnotte B. Pathogenesis of immune thrombocytopenia. Autoimmun Rev. 2017; 16 (6): 620-32. https://doi.org/10.1016/j.autrev.2017.04.012, PMid: 28428120.
[8] Hakim AJ, Machin SJ, Isenberg DA. Autoimmune thrombocytopenia in primary antiphospholipid syndrome and systemic lupus erythematosus: The response to splenectomy. Semin Arthritis Rheum. 1998; 28 (1): 20-5. https://doi.org/10.1016/ s0049-0172 (98) 80024-3, PMid: 9726332.
[9] Zhao H, Li S, Yang R. Thrombocytopenia in patients with systemic lupus erythematosus: Significant in the clinical implication and prognosis. Platelets. 2010; 21 (5): 380-5. https://doi.org/10.3109/09537101003735564, PMid: 20433308.
[10] Hazzan R, Mukamel M, Yacobovich J, Yaniv I, Tamary H. Risk factors for future development of systemic lupus erythematosus in children with idiopathic thrombocytopenic purpura. Pediatr Blood Cancer. 2006; 47 (5): 657-9. https://doi.org/10.1002/ pbc.20970, PMid: 16933242.
[11] Altintas A, Ozel A, Okur N, Okur N, Cil T, Pasa S, Ayyildiz O. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis. 2007 Oct; 24 (2): 163-8. doi: 10.1007/s11239-007-0031-y. Epub 2007 Apr 14. PMID: 17436144.
[12] Campos LM, Spadoni MS, Michelin CM, Jesus AA, Carneiro JD, da Silva CA. Thrombotic thrombocytopenic purpura at presentation of juvenile systemic lupus erythematosus patients. Rev Bras Reumatol. 2013 Feb; 53 (1): 120-6. English, Portuguese. PMID: 23588522.
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    Rizwanullah, Shehriyar, Khayam, Muhammad Saad, Aiysha Gul. (2023). Isolated Thrombocytopenia as an Initial Presentation of Systemic Lupus Erythematosus: A Case Report of a 17 Year Old Female. American Journal of Internal Medicine, 11(3), 60-63. https://doi.org/10.11648/j.ajim.20231103.16

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    ACS Style

    Rizwanullah; Shehriyar; Khayam; Muhammad Saad; Aiysha Gul. Isolated Thrombocytopenia as an Initial Presentation of Systemic Lupus Erythematosus: A Case Report of a 17 Year Old Female. Am. J. Intern. Med. 2023, 11(3), 60-63. doi: 10.11648/j.ajim.20231103.16

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    AMA Style

    Rizwanullah, Shehriyar, Khayam, Muhammad Saad, Aiysha Gul. Isolated Thrombocytopenia as an Initial Presentation of Systemic Lupus Erythematosus: A Case Report of a 17 Year Old Female. Am J Intern Med. 2023;11(3):60-63. doi: 10.11648/j.ajim.20231103.16

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  • @article{10.11648/j.ajim.20231103.16,
      author = {Rizwanullah and Shehriyar and Khayam and Muhammad Saad and Aiysha Gul},
      title = {Isolated Thrombocytopenia as an Initial Presentation of Systemic Lupus Erythematosus: A Case Report of a 17 Year Old Female},
      journal = {American Journal of Internal Medicine},
      volume = {11},
      number = {3},
      pages = {60-63},
      doi = {10.11648/j.ajim.20231103.16},
      url = {https://doi.org/10.11648/j.ajim.20231103.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20231103.16},
      abstract = {Background: Childhood systemic lupus erythematosus (SLE) can manifest in various ways, with hematologic abnormalities being common. However, isolated thrombocytopenia is relatively infrequent. Case Presentation: In this case report, we describe a 17-year-old female patient who presented with complaints of generalized body aches, weakness, anorexia, and recent epistaxis, with no relevant medical history, medication use, smoking, or bleeding disorder in the family. After excluding infectious and other autoimmune causes, SLE was the final diagnosis due to high ANA and anti-dsDNA titers. Despite conventional steroid therapy, the patient's platelet count remained low, prompting the increase of prednisolone up to 2mg/kg/day. By day 7th, the platelet numbers reached to 85000/μl, indicating a favorable response. Conclusion: Our findings suggest that when isolated thrombocytopenia does not respond to conventional steroid therapy, SLE should be considered, and that a child presenting with isolated hematological abnormality should be screened for childhood-onset SLE.},
     year = {2023}
    }
    

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    AU  - Rizwanullah
    AU  - Shehriyar
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    AB  - Background: Childhood systemic lupus erythematosus (SLE) can manifest in various ways, with hematologic abnormalities being common. However, isolated thrombocytopenia is relatively infrequent. Case Presentation: In this case report, we describe a 17-year-old female patient who presented with complaints of generalized body aches, weakness, anorexia, and recent epistaxis, with no relevant medical history, medication use, smoking, or bleeding disorder in the family. After excluding infectious and other autoimmune causes, SLE was the final diagnosis due to high ANA and anti-dsDNA titers. Despite conventional steroid therapy, the patient's platelet count remained low, prompting the increase of prednisolone up to 2mg/kg/day. By day 7th, the platelet numbers reached to 85000/μl, indicating a favorable response. Conclusion: Our findings suggest that when isolated thrombocytopenia does not respond to conventional steroid therapy, SLE should be considered, and that a child presenting with isolated hematological abnormality should be screened for childhood-onset SLE.
    VL  - 11
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Author Information
  • Department of Medicine, Hayatabad Medical Complex, Peshawar, Pakistan

  • Department of Medicine, Hayatabad Medical Complex, Peshawar, Pakistan

  • Department of Medicine, Combined Military Hospital, Peshawar, Pakistan

  • Department of Medicine, Hayatabad Medical Complex, Peshawar, Pakistan

  • Depatment of Gynaecology and Obstetrics, Hayatabad Medical Complex, Peshawar, Pakistan

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