Hemorrhagic plaques in the oral cavity: A clue to diagnosing thrombocytopenia

Aswathi Raj,Vishal Bejai,Spandana P Hegde,Manjunath Shenoy M,Malcolm Pinto,Amina Asfiya,Ashmiya Abdul Razak

doi:10.7241/ourd.20212.14

Abstract

Idiopathic thrombocytopenic purpura is a disorder with a myriad of possible clinical presentations. The mechanism of thrombocytopenia involves both increased platelet destruction and impaired platelet production. The patient can manifest a wide range of symptoms: from asymptomatic or minimal gingival bleeding to profuse bleeding from any site. The disease may first present itself to the dermatologist in cutaneous findings such as petechiae, purpura, and mucosal manifestations in the form of gingival bleeding and hemorrhagic bullae. The diagnosis of idiopathic thrombocytopenic purpura is mostly done by exclusion. In this report, we present two cases with characteristic oral manifestations, who were diagnosed, on investigation, with idiopathic thrombocytopenic purpura. The patients were successfully treated with immunosuppressive therapy. The report aims to raise awareness that would help in enabling prompt referral to the appropriate specialty, especially because of the rarity of this presentation.

Highlights

Idiopathic thrombocytopenic purpura (ITP) is a disorder characterized by a low platelet count, usually of no known cause
ITP, known as Werlhof’s disease, is caused by antibody and cell-mediated platelet destruction and suppression of platelet production, which may occur without any predisposing factor or secondary due to other conditions, including autoimmune disorders, neoplasms, congenital immune deficiencies, drugs, and infections
There are two clinical subtypes of primary ITP: acute primary ITP, a self-limited form commonly seen in children subsequent to viral infections, and chronic primary ITP, more commonly seen in young adult females between 20 to 40 years of age

Summary

INTRODUCTION

Idiopathic thrombocytopenic purpura (ITP) is a disorder characterized by a low platelet count (thrombocytopenia), usually of no known cause (idiopathic). The patient admitted to having noticed multiple asymptomatic flat and red lesions over both legs for ten days prior. She had associated low-grade fever, constitutional symptoms, and reduced appetite and sleep for two weeks prior. An examination of the oral cavity revealed multiple ulcers with surrounding hemorrhagic plaques over the buccal mucosa (Fig. 3). The second patient was a 36-year-old male who presented himself with an asymptomatic dark lesion in the oral cavity and the right side of the tongue for fifteen days prior. An examination of the oral cavity revealed a hemorrhagic plaque over the posterior part of the right buccal mucosa and a smaller plaque over the right lateral border of the tongue

DISCUSSION

CONCLUSION