International Journal of Contemporary Pediatrics | March 2021 | Vol 8 | Issue 3 Page 588 International Journal of Contemporary Pediatrics Badarayan KV et al. Int J Contemp Pediatr. 2021 Mar;8(3):588-589 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 Case Report Immune thrombocytopenic purpura with psoriasis: a rare association in children Karthik V. Badarayan*, Jitendra S. Oswal, Sunil V. Kapur INTRODUCTION It is known that approximately 80% of Immune thrombocytopenic purpura (ITP) patients suffer from the primary form and the remaining have a secondary form. 1 The diseases associated with the secondary form include lupus erythematosus (5%), infections like HCV, HIV, and Helicobacter pylori (6%), post-vaccination (1%), antiphospholipid syndrome (2%), lymphoma (2%) and Evans syndrome (2%). 2 It may take months or even years until the clinical manifestation of the associated disease becomes obvious. Eg. malignancies. However, systematic analysis of the incidence of secondary ITP is lacking. 2 CASE REPORT A 11 years old female child, presented with erythematous non pruritic scaly rash over her scalp, axilla and elbows since 1 month (Figure 1). This was followed by multiple petechial rash all over her body (Figure 2). No history of other bleeding manifestation, night sweats, oral ulcers, icterus, headaches, visual disturbances or joint swelling. Rest of her past and family history was unremarkable. Birth, development and immunization history was uneventful. Anthropometric parameters and vitals including blood pressure were normal. Clinical examination revealed scaly dermatitis over her scalp, both the axillae and elbows along with multiple petechial rash all over her body and other systemic examination within normal limits. Laboratory investigations showed isolated thrombocytopenia (haemoglobin- 11.8 g/dl, total leukocyte count- 10000/cumm and platelets <10,000/cumm). Her coagulation tests were normal. Bone marrow examination findings were consistent with peripheral platelet destruction. For her scaly dermatitis, skin biopsy was done from her right axilla which showed parakeratosis and thickened projections of the prickle cell layer of keratinocytes suggestive of psoriasis [Figure 3]. Human immunodeficiency virus, Hepatitis B and Hepatitis C tests were negative. Thyroid function, Renal function and liver function tests were within normal range. Anti- nuclear antibody by Immunofluorescence method had insignificant titre (1:100). Erythrocyte sedimentation rate, C-reactive protein, C3 and C4 levels were normal. Direct coomb’s test and Antiphospholipid antibody test was negative. In our patient, ITP with Psoriasis was diagnosed based on isolated thrombocytopenia, bone marrow findings and skin biopsy proven psoriasis. She was started on oral prednisolone at 2 mg/kg/day and her subsequent platelet counts showed an improving trend as well her psoriatic ABSTRACT Autoimmune thrombocytopenia (ITP) is one of the best characterized autoimmune diseases which is classified into primary (idiopathic) and secondary forms. A high index of suspicion is warranted for the diagnosis of secondary ITP. There is limited data on association of ITP with Psoriasis. We herein describe a 11 years old girl who presented with a rare association of ITP and Psoriasis who responded to oral steroids. Keywords: Autoimmune thrombocytopenia, Psoriasis, Pediatrics Department of Pediatrics, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India Received: 31 December 2020 Accepted: 30 January 2021 *Correspondence: Dr. Karthik V. Badarayan, E-mail: Karthik.vbadarayan@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20210672