Tonsil bleeding in immune thrombocytopenia (ITP)

Laryngo-Rhino-Otologie, vol. 103, pp. S306

Abstract

Introduction Mucosal hemorrhages can be a leading symptom in the diagnosis of ITP. It is important to avoid the occurrence of further bleeding and to evaluate its pathogenesis. Material/Methods A 14-year-old female patient presented with left-sided odynophagia and blood in the saliva. Clinically, there was tonsillar hyperplasia on the left side with an exophytic, bluish discolored mass at the upper pole of the left tonsil without evidence of active bleeding. The patient was admitted to hospital for analgesia, antibiotics and cortisone. Laboratory tests revealed a thrombocytopenia of 30/nl and elevated transaminases. After administration of a platelet concentrate, the platelets rose to 73/nl; two days later, however, they were again at 41/nl. The EBV serology proved positive. In consultation with the pediatricians and hematologists, we suspected an ITP with consecutive tonsil bleeding due to EBV tonsillitis; a tonsil malignancy was considered as a differential diagnosis. The MRI neck examination showed a left tonsil tissue plus and bilateral cervical lymphadenopathy. In the chest X-ray examination, mediastinal widening and pulmonary foci could be excluded. Abdominal ultrasonography showed hepatosplenomegaly. In the course of the procedure, the thrombocytes normalized so that the mass was excised. Histologically, there was inflammation and necrosis without evidence of malignancy. Results The patient was discharged after 12 days in good general condition and with normal laboratory parameters. There were no further bleedings. Discussion Tonsil hematoma or intraoral bleeding require the determination of the platelet count. In symptomatic ITP, monitoring is recommended to prevent bleeding and respiratory complications and an interdisciplinary treatment concept is advisable. Publication History Article published online: 19 April 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Authors 2

1. Anne Hapke Aachen Klinik für Hals-

   Universitätsklinikum Aachen

   Affiliation as printed

   Universitätsklinikum Aachen, Klinik für Hals-, Nasen-, Ohrenheilkunde, Aachen

2. Sebastian Philipp Schraven Aachen Klinik für Hals-

   Universitätsklinikum Aachen

   Affiliation as printed

   Universitätsklinikum Aachen, Klinik für Hals-, Nasen-, Ohrenheilkunde, Aachen