Abstract
To investigate the aetiology of multiple ecchymoses associated with eosinophilia. Professorial Paediatric Unit (PPU) at Lady Ridgeway Hospital (LRH) for children, Colombo. Prospective study from July 1998 to April 2000. Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia (> 1 x 10(9)/1) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed. Patients who were positive for toxocara were treated either with thiabendazole or albendazole. Patients who had geohelminth infestations were treated with mebendazole. 14 children (11 boys) were studied. 7 were between 1 and 5 years, and 7 were above 5 years of age. The mean eosinophil count was 4.3 x 10(9)/1. All patients had a prolonged bleeding time, but clotting time and platelet counts (mean value 220 x 10(9)/1) were normal. Platelet function tests were done in 5 patients. Twelve patients were positive for toxocariasis and the other 2 were positive for ascariasis. All children who were positive for toxocariasis had contact with pet cats or dogs. Six patients were treated with thiabendazole and 6 with albendazole. The two patients who had ascariasis were treated with mebendazole. Post-treatment mean eosinophil count was 0.63 x 10(9)/1, and the bleeding time was 4 minutes. Toxocariasis could present with ecchymoses due to an acquired bleeding disorder. Awareness of this would help to investigate, diagnose and treat early, and lessen parental anxiety.
Highlights
MethodsPatients admitted to the Professorial Paediatric Unit (PPU) with multiple ecchymoses associated with an absolute eosinophilia ( > l x l 0 7 l ) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed
Ecchymoses usually occur with thrombocytopaenia and commonly would be the presenting symptom of immune thrombocytopaenic purpura or bone marrow infiltration
We came across a group of children who had ecchymoses with normal platelet counts and eosinophilia
Summary
Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia ( > l x l 0 7 l ) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed. Toxocara antibody tests in the serum were performed at the Department of Parasitology, University of Peradeniya by an ELISA test based on detection of antibodies to excretory and secretory antigens (ESA) extracted from Toxocara canis L2 larvae cultured in vitro. This test has a 78% sensitivity and 92% specificity in VLM (2). Patients with an OD values more than 0.2 were considered as positive for toxocariasis in the absence of a previous history of treatment for VLM
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