{"id":1615,"date":"2021-03-23T07:11:16","date_gmt":"2021-03-23T07:11:16","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-newsletters\/?p=1615"},"modified":"2025-04-11T03:53:29","modified_gmt":"2025-04-11T03:53:29","slug":"thrombocytopenia-followed-by-generalised-lymphadenopathy","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-march-2021\/thrombocytopenia-followed-by-generalised-lymphadenopathy\/","title":{"rendered":"Thrombocytopenia Followed By Generalised Lymphadenopathy"},"content":{"rendered":"

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Case Presentation<\/strong><\/h2>\n

A 66-year-old female, known case of diabetes, hypertension<\/a> and hypothyroidism for more than 10 years, presented with the following: 1) high-grade continuous fever with rashes which started on both forearms and spread to involve\u00a0 a trunk associated with itching 2) Odynophagia since 10 days. There was past history of fever with thrombocytopenia before 6 months. Dengue IgM was positive, But platelet was persistently low even after 2 weeks of fever onset and reached a level of 2000 cells\/ microlitre by third week, which was not consistent with natural history of dengue, and also previous medical records have shown low platelet counts (less than 1lakh) consistently. After extensive workup for thrombocytopenia, the patient was diagnosed to have ITP and started on steroid and azathioprine.<\/p>\n

On Examination<\/strong><\/h2>\n

Febrile (99.60 <\/sup>F), blanching maculopapular rashes with target lesion were present predominantly over extremities and multiple firm non-tender non-matted mobile lymph nodes of greater than 1cm were palpated over bilateral anterior cervical, axillary and inguinal regions. Oral thrush was present.<\/p>\n

\"Skin<\/p>\n

Figure 1 <\/strong>– Skin Lesion <\/strong><\/p>\n

Investigations<\/strong><\/h2>\n

Hb-9.9 g\/dl, total count \u2013 14000(N36%,L34%,E28%,M2%,B0%), Platelet – 165000, Peripheral smear \u2013 eosinophilia, no blast cells, Absolute eosinophil count \u2013 3920 cells\/ microlitre, serum IgE level normal,RFT, LFT, urine routine \u2013 no significant abnormality, CTchest and abdomen \u2013 multiple significant mediastinal, right hilar, peri gastric, peri-pancreatic iliac and aortic lymph nodes present with no central necrotic area. No splenomegaly or lung infiltrates.Dengue NS1\/IgM, MPQBC, COVID 19 \u2013 negative, Blood culture \u2013 negative, Anti VCA IgM & IgG for EBV negative, IgM for leptospirosis and scrub typhus- negative.<\/p>\n

Problem<\/strong><\/h2>\n