Dr.Akshay Kishore , Dr.C.Jayakumar , Dr. Suchithra Sivadas AIMS kochi.
17 year old boy apparently normal not on any se medication till now presented with a contusion over his abdomen alleged to have occurred following a hit with the elbow his friend Subsequently two such contusion developed over his loin and in the fore arm
Differential diagnosis considered were a
Trauma
Thrombocytopenia or Thrombo cytopathy
Malignancy
Cellulitis
Dermatitis artefacta
Boy was not sick looking
Vitals – Stable ,PICCLE normal,no organomegaly/or bleeds from any other sites
Labs showed- Eosinophilia 33%
Absolute eosinophil count -1500
Platelets – Normal (1,75,000)
Hb- 12.8 , Hct – 39
RFT/LFT/PT INR ,PS coagulation profile were normal
Platelet function study was done which showed abnormal aggregation pattern against high ADP , collagen and epinephrine The study was suggestive of acquired platelet function defect with eosinophilia (APDE) syndrome.
Child was started on Diethylcarbamazine 6mg/kg /day for 14 days and Albendazole single dose and advised to review after 2week. He was better and medications were stopped. He is under follow up.
Diagnosis- Acquired Platelet function defect or dysfunction with Eosinophilia syndrome ( APDE syndrome)
APDE Syndrome
◦ Presents as spontaneous bleeding/ Ecchymosis
◦ 86% of children with syndrome has eosinophilia
◦ Parasitic infection with Strongyloides stercoralis Can be associated with it
◦ Abnormal platelet aggregation induced collagen is the most common abnormality reported in these patients
◦ Hallmark of this syndrome is recurrent spontaneous bruising, normal hematocrit and normal number of platelets
◦ No specific treatment has been found to be useful except in some instances, empirical usage of antihelmenthics is beneficial
Carry home manage
Diaganosis of Acquired platelet function defect with Eosinophilia is a great relief for parents and also and we could avoid invasive processes for the child