Initial Identification of Immune Thrombocytopenia by a Dentist: A Case Report

Abstract

Immune thrombocytopenia (ITP) is an autoimmune disease defined as decreased platelet count which is caused by antiplatelet autoantibodies. Here we present a case of elderly patient who exhibited petechiae in oral mucosa and forearm which was found by the dentist and subsequently diagnosed as ITP by the hematologist. An 89-year-old male who had a chief complaint of the problem about his denture visited a general dental practitioner. As the dentist noticed the lesion like a hematoma on the left side of the tongue, he was introduced to our hospital. His medical history revealed that he had undergone the operation of stoma 20 years ago. He had full maxillary and mandibular dentures, but did not recall biting his tongue on his own. On physical examination, soft dark purple hematomas on the bilateral side of the tongue. We initially suspected a traumatic hematoma. However, multiple petechial hemorrhages were present on the oral mucosa, namely, subcutaneous hemorrhages on the palate and the bilateral buccal mucosa. Moreover, when the extremities were checked, some purpura were observed. Laboratory data showed the following: platelet 18,000 /μL. We consulted with the hematologist. A thorough examination revealed that the patient had ITP. Dentists should consider the possibility of encountering unaware ITP patients.