A case of Kawasaki disease complicating Immune thrombocytopenic purpura

Abstract

We report the case of Kawasaki disease （KD） complicating Immune thrombocytopenic purpura （ITP）. A 1-year-old girl with fever, rash, bilateral conjunctival injection, injected lips and pharynx, cervical lymphadenopathy, erythema of the palms or soles and swelling of hands and feet was referred to us with thrombocytopenia （1.6 × 104/μL） on the 3rd day after the onset of fever. The diagnosis of KD was made. Treatment with intravenous immunoglobulin was started. The symptoms related to KD were all improved but thrombocytopenia persisted. The level of platelet-associated immunoglobulin was elevated. Bone marrow aspiration revealed an increase of immature megakaryocytes. The diagnosis of ITP was made. Treatment with prednisolone was started and thrombocytopenia was gradually improved. Cardiac involvement associated with KD was not observed. Although most patients with KD showed thrombocytosis during the acute phase, some patients showed thrombocytopenia. The rate of thrombocytopenia association in KD has been reported as about 2 %. The cause of thrombocytopenia association in KD were disseminated intravascular coagulation, drug related thrombocytopenia, macrophage activation syndrome and so on. ITP should be considered as a cause of thrombocytopenia in patients with KD, although it might be rare.