Concluded Case

What's the diagnosis or what investigation should be done further?

A 11 year old boy has bruises all over the body since last 1 or 2 month. These bruises sometimes disappear and also new bruises appear elsewhere. No other symptoms seen. I've attached his investigation reports along with this. Chief Complaints Skin bruises on hand, buttocks, thigh and leg. History No previous history Physical Examination Some of the bruises seem nodular when palpated. Investigations Bleeding time, clothing time, peripheral blood smear, cbc have been done. Eosinophilia (14%) seen on peripheral blood smear. Diagnosis Experts advice needed Management Need advice

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Concluded answer

H S Purpura , ps ,platelets, CT, but,pt,aptt, urine routine, esr, biopsy palpable skin lesion. Palpable purpura=HSP. Confirm diagnosis and decide treat.

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Brusing is very common in childhood & usually self limiting, If der r large bruising,out of proportion to injury, If bruising without fall,// Bruising lasting more time (Weeks) to resolve,// ??family h/ Bleeding (Von Willibrand disease,/Haemophilia/hereditary) If Bleeding in joints, epistaxis( Bleeding >10 minutes) If associated with fever, wt.loss,bony tenderness??Leukemia Adv. CBC,PS exam, PT,Partial PT,(PTT) Factor Vlll,Factor lX, Factor XI, Von willibrand Factor, Depending upon the work up, case can be managed.

Thank you doctor
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good case . eosinophilic purpura . do get examined stool for worm infestation . platelet aggregation study .

@Nitesh Prasad there's no abdominal pain noted on PE. So the chance for worm infestation can be ruled out I guess.
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H S Purpura , ps ,platelets, CT, but,pt,aptt, urine routine, esr, biopsy palpable skin lesion. Palpable purpura=HSP. Confirm diagnosis and decide treat.

@Muralidhar Laxmanrao Kulkarni the skin bruises differ from the ones in HSP.
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BRUISES.. WITH.. EOSINOPHILIA.. ? VASCULOPATHY.. NEED'S TO R/O CAUSES OF.. EOSINOPHILIA..AND.. MANAGEMENT ACCORDINGLY..

Valuable opinion
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BT and CT are useless tests. Ask for family history of bleeding. There is a pediatric bleeding assessment test you can use to assess the severity of bleeding. Do a PT and APTT to start with. Remember that vWD the most common bleeding disorder can have a normal PTT. So if the history and BAT is sugggestive of bleeding disorder test for vWF Level and vWF.RCO activity even if PTT is normal. If testing is still normal and history is very suggestive would do a platelet aggregation study. See a hematologist if possible

Utricaria. Deworming to be done

Thank you doctor
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PT/aPTT....?

@Dr. Sunil Soni Thanks for the opinion.
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PT , APTT to be done

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