Abstract
Introduction
Childhood immune thrombocytopenia (ITP) affects 5 in 100,000 children per year. It is an autoimmune disease associated with impaired platelet production as well as immune‐mediated platelet destruction, resulting in low platelet counts. Approximately 20% pursue a chronic course, which is defined as a platelet count that has been < 10 ×109/L for longer than 12 months, with some cases requiring long-term immunosuppressive therapy, resulting in a greater risk of infectious complications.
Case Presentation
A 14-year-old, obese adolescent girl with chronic immune thrombocytopenic purpura, treated with a combination of dexamethasone, vincristine, and elthrombopag, presented with a 7-day history of acute fever and left hip pain, which was caused by infections from three different pathogens: (1) left hip with septic arthritis caused by Citrobacter freundii, (2) urinary tract infection caused by Escherichia coli and (3) typhoid fever caused by Salmonella typhi. The left purulent hip was operatively drained along with broad-spectrum intravenous antibiotic treatment for 3 weeks, after which the patient’s condition significantly improved.
Conclusion
Children with chronic ITP who undergo long-term immunosuppressive therapy are prone to the risk of serious concurrent infections by different pathogens, as shown in our case in an obese pediatric patient in which obesity is known to be related to osteoarthritis in weight-bearing joints, but the actual risk is not well studied and needs further observational evidence.