Pediatr Infect Vaccine.  2015 Aug;22(2):117-120. 10.14776/piv.2015.22.2.117.

A Case of Acute Idiopathic Thrombocytopenic Purpura Following Influenza B Virus Infection

• Jung S
• Kang S
• Kang JH
• Ma SH

• KMID: 2465257
• DOI: http://doi.org/10.14776/piv.2015.22.2.117

Abstract

Virus-associated immune thrombocytopenic purpura (ITP) can occur following common viruses, but cases of ITP associated with influenza infection has seldom been reported. In this report we describe a previously healthy 5-year-old boy who admitted with fever, flu-like symptoms and a few bruises on both legs. Severe thrombocytopenia were found. Bone marrow aspirates and biopsy showed no abnormalities and results of coagulation tests were all in normal limit. Real-time polymerase chain reaction was positive for influenza B infection. The patient fully recovered with intravenous immunoglobulins and steroid therapy.

Keyword

Idiopathic thrombocytopenic purpura; Influenza

MeSH Terms

Biopsy
Bone Marrow
Child, Preschool
Contusions
Fever
Humans
Immunoglobulins, Intravenous
Influenza B virus*
Influenza, Human*
Leg
Male
Purpura, Thrombocytopenic, Idiopathic*
Real-Time Polymerase Chain Reaction
Thrombocytopenia
Immunoglobulins, Intravenous

Reference

1. Scott JP, Montgomery RR. Platelet and blood vessel disorder. In : Kligeman RM, Stanton BF, St Geme JW, Schor NF, Berhman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: WB Saunders Elsevier;2011. p. 1714–1717.

2. Yenicesu I, Yetgin S, Ozyurek E, Aslan D. Virus-associated immune thrombocytopenic purpura in childhood. Pediatr Hematol Oncol. 2002; 19:433–437.

3. Shizuma T. Immune thrombocytopenia following influenza virus infection and influenza vaccine administration. Virol Mycol. 2014; S2:003.

4. Rice J, Resar LM. Hematologic abnormalities associated with influenza A infection: a report of 3 cases. Am J Med Sci. 1998; 316:401–403.

5. Wolf DG, Greenberg D, Kalkstein D, Shemer-Avni Y, Givon-Lavi N, Saleh N, et al. Comparison of human metapneumovirus, respiratory syncytial virus and influenza A virus lower respiratory tract infections in hospitalized young children. Pediatr Infect Dis J. 2006; 25:320–324.

6. Nichols JE, Niles JA, Roberts NJ Jr. Human lymphocyte apoptosis after exposure to influenza A virus. J Virol. 2001; 75:5921–5929.

7. Hinshaw VS, Olsen CW, Dybdahl-Sissoko N, Evans DJ. Apoptosis: a mechanism of cell killing by influenza A and B viruses. J Virol. 1994; 68:3667–3673.

8. Sedger LM, Hou S, Osvath SR, Glaccum MB, Peschon JJ, van Rooijen N, et al. Bone marrow B cell apoptosis during in vivo influenza virus infection requires TNF-alpha and lymphotoxin-alpha. J Immunol. 2002; 169:6193–6201.

9. Wang CC, Chen PY, Wang JD, Liu FC, Huang FL, Lee CY. Clinical and laboratory analysis of influenza B infection in children in Taichung, Taiwan during the 2006–2007 flu season. Pediatr Neonatol. 2009; 50:54–58.

10. Ikegame K, Kaida K, Fujioka T, Kawakami M, Hasei H, Inoue T, et al. Idiopathic thrombocytopenic purpura after influenza vaccination in a bone marrow transplantation recipient. Bone Marrow Transplant. 2006; 38:323–324.

11. Tishler M, Levy O, Amit-Vazina M. Immune thrombocytopenic purpura following influenza vaccination. Isr Med Assoc J. 2006; 8:322–323.

12. Mantadakis E, Farmaki E, Thomaidis S, Tsalkidis A, Chatzimichael A. A case of immune thrombocytopenic purpura after influenza vaccination: consequence or coincidence? J Pediatr Hematol Oncol. 2010; 32:e227–e229.

13. Casoli P, Tumiati B. Acute idiopathic thrombocytopenic purpura after anti-influenza vaccination. Medicina (Firenze). 1989; 9:417–418.

14. Montagnani S, Tuccori M, Lombardo G, Testi A, Mantarro S, Ruggiero E, et al. Autoimmune hemolytic anemia following MF59-adjuvanted influenza vaccine administration: a report of two cases. Ann Pharmacother. 2011; 45:e8.

15. Scott S, Reimers HJ, Chernesky MA, Greenberg JP, Kinolugh-Rathbone RL, Packham MA, et al. Effect of viruses on platelet aggregation and platelet survival in rabbits. Blood. 1978; 52:47–55.

16. Lee CY, Wu MC, Chen PY, Chou TY, Chan YJ. Acute immune thrombocytopenic purpura in an adolescent with 2009 novel H1N1 influenza A virus infection. J Chin Med Assoc. 2011; 74:425–427.

17. Kaneko H, Ohkawara Y, Nomura K, Horiike S, Taniwaki M. Relapse of idiopathic thrombocytopenic purpura caused by influenza A virus infection: a case report. J Infect Chemother. 2004; 10:364–366.