46 https://oamjms.eu/index.php/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2022 Jan 31; 10(C):46-49. https://doi.org/10.3889/oamjms.2022.8174 eISSN: 1857-9655 Category: C - Case Reports Section: Case Report in Pediatrics Immune Thrombocytopenia as the Initial Manifestation of Pediatric Systemic Lupus Erythematosus: Case Reports Harapan Parlindungan Ringoringo* Department of Child Health, Faculty of Medicine, Lambung Mangkurat University, RSD Idaman Banjarbaru, Banjarbaru, Indonesia Abstract BACKGROUND: Immune thrombocytopenia (ITP) can precede the onset of systemic lupus erythematosus (SLE) by months to years. CASE PRESENTATION: A 12-year-old girl weighing 46 kg came to the hospital with the complaint of 12 days- menstrual bleeding. The patient is weak, pale. Eyes, ENT, heart, lungs, abdomen: within normal limits, no petechiae. Laboratorium: Hemoglobin (Hb) 4.6 g/dL, leukocytes 12,930/uL, platelets 11,000/uL, hematocrit 15%, Dif Count: normal. Red blood cell (RBC) 1.59 million/uL, mean corpuscular volume (MCV) 94.3fL, mean corpuscular hemoglobin (MCH) 28.9pg, MCH concentration 30.7%, RDW-CV 14.6%. Corrected-reticulocytes 5.16%, Ret-He 22.6, IPF 54.17%. Peripheral blood smears normochromic, normocytic, blast not found, platelets are rare. The diagnosis is menometrorrhagia with anemia due to bleeding caused by ITP. The patient was given PRC and platelet transfusion, methylprednisolone. Three months later, the patient had another prolonged menstruation, hair loss, no petechiae, or purpura. Laboratorium: Hb 8.2 g/dL, leukocytes 7800/uL, platelets 6000/uL, RBC 1.59 million/uL, MCV 94.3fL, MCH 28.9pg, corrected reticulocytes 5.08%, Ret-He 24.6, IPF 54.5%. ANA test positive, Anti dsDNA-NcX 190.2 IU/ml. The diagnosis is SLE. During the last 16 months, the patient took 10 mg prednisone with a platelet count >150,000/uL. CONCLUSION: In every case of ITP in a child, consider the possibility of SLE. Edited by: Igor Spiroski Citation: Ringoringo HP. Immune Thrombocytopenia as the Initial Manifestation of Pediatric Systemic Lupus Erythematosus: Case Reports. Open Access Maced J Med Sci. 2022 Jan 31; 10(C):46-49. https://doi.org/10.3889/oamjms.2022.8174 Keywords: Immune thrombocytopenia; Systemic lupus erythematosus; ANA; Child *Correspondence: Dr. Harapan Parlindungan Rigoringo, Department of Child Health, Faculty of Medicine, Lambung Mangkurat University – RSD Idaman Banjarbaru, Indonesia. E-mail: parlinringoringo@ulm.ac.id Received: 05-Dec-2021 Revised: 21-Jan-2022 Accepted: 24-Jan-2022 Copyright: © 2022 Harapan Parlindungan Ringoringo Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interests Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Immune thrombocytopenia (ITP) can precede the onset of systemic lupus erythematosus (SLE) by months to years. The incidence of pediatric ITP is 4.3/100,000 people/year [1]. The incidence of SLE in patients with ITP and the potential relationship between them is still unclear. Zhu et al. reported that SLE incidence in ITP patients and SLE incidence in non-ITPs was 4.7% and 0.19%, respectively. ITP patients had a 26-fold risk of developing SLE than the control group in the population. Furthermore, men have a lower risk of developing SLE than women [2]. Case Presentation A 12-year-old girl weighing 46 kg came to the hospital with the complaint of 12 days-massive menstrual bleeding. Previously the patient had frequent nosebleeds. On physical examination, the patient is conscious, weak, pale. Eyes, ENT, heart, lungs, abdomen: within normal limits, no petechiae. On laboratory tests: Hb 4.6 g/dL, leukocytes 12,930/uL, platelets 11,000/uL, hematocrit 15%, Dif Count: basophils 0%, eosinophils 0%, stems 1%, segments 71%, lymphocytes 24%, monocytes 4%. Red blood cell (RBC) 1.59 million/uL, mean corpuscular volume (MCV) 94.3fL, mean corpuscular hemoglobin (MCH) 28.9pg, MCH concentration (MCHC 30.7%, RDW-CV 14.6%. Corrected reticulocytes 5.16%, Ret-He 22.6, IPF 54.17%. Peripheral blood smear features normochromic, normocytic, blast not found, platelets are rare. The diagnosis is menometrorrhagia with anemia due to bleeding caused by ITP. The patient was given 5 × 250 ml PRC transfusion, 10U platelet transfusion, 50 mg of methylprednisolone intravenous every 12 h for 3 days, followed by 30 mg intravenous for 4 days. The patient went home in good condition. The patient lost to follow-up. Three months later, the patient had another prolonged massive menstruation, appeared Malar rash on the cheeks, and hair loss in several places on the head. On the skin, there is no petechiae or purpura. Laboratory examinations: Hb 8.2 g/dL, leukocytes 7800/uL, platelets 6000/uL, hematocrit 25.1%, Dif Count: basophils 0%, eosinophils 5%, stems 1%, segments 60%, lymphocytes 29%, monocytes 5%. RBC 1.59 million/uL, MCV 94.3fL, MCH 28.9pg, MCHC 30.7%, RDW-CV 14.6%. Corrected reticulocytes 5.08%, Ret-He 24.6, IPF 54.5%. Urinalysis within normal limits.