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E-IJD CORRESPONDENCE
Year : 2016  |  Volume : 61  |  Issue : 2  |  Page : 236
Idiopathic thrombocytopenic purpura masquerading pediatric systemic lupus erythematosus


Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Web Publication1-Mar-2016

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.177785

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How to cite this article:
Al-Mendalawi MD. Idiopathic thrombocytopenic purpura masquerading pediatric systemic lupus erythematosus. Indian J Dermatol 2016;61:236

How to cite this URL:
Al-Mendalawi MD. Idiopathic thrombocytopenic purpura masquerading pediatric systemic lupus erythematosus. Indian J Dermatol [serial online] 2016 [cited 2021 Oct 25];61:236. Available from: https://www.e-ijd.org/text.asp?2016/61/2/236/177785


Sir,

I read with interest the case report by Barara and Garg on a child with systemic lupus erythematosus (SLE) who was initially presented with thrombocytopenia and diagnosed as idiopathic thrombocytopenic purpura (ITP).[1] It is worthy to mention that assessing pediatric patients, with thrombocytopenia represents a major challenge in the clinical settings as 15% of ITP patients in India, have been noticed to fulfill the diagnosis of SLE on detailed evaluation.[2] Barara and Garg stated in their study that the presence of high titer of anti-nuclear antibodies (ANA) is a sensitive marker for future development of SLE in patients with ITP.[1] They did not support that notion with references. Reviewing the literature revealed that only two studies that did not support the contribution of ANA titer to the prediction of SLE in ITP patients. The first study involved a retrospective analysis of 365 children and 108 adult patients with ITP and patients found to have positive ANA were regularly followed up for a mean of 3.6 years (range: 2.1–7 years) for the development of symptoms indicative of autoimmune disorders. The study showed that ANA positivity was often found in adult and children patients with ITP and indicated that the detection of ANA positivity was not enough to identify those patients with ITP who are at risk of developing SLE or other connective tissue diseases. Moreover, there was a statistically significant difference in terms of ANA positivity between childhood acute and chronic ITP patients. The study concluded that ANA positivity might be an indicator in terms of chronicity for childhood ITP.[3] The second study recruited 222 children with ITP who were followed for a mean of 4.2 ± 4.9 years. The study revealed that the majority of children with ITP who had a positive ANA (64%) did not develop SLE.[4] I, therefore, presume that it is essential to periodically monitor ITP patients for other clinical data of SLE rather than solely relying on ANA titer serial measurement. Apart from scrutinizing ITP patients for cutaneous lesions as recommended by Barara and Garg,[1] fever and arthralgia are additionally paramount to be regularly checked as they were proved to be the most predominant clinical characteristics in Indian SLE pediatric patients.[2]

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   References Top

1.
Barara M, Garg T. Idiopathic thrombocytopenic purpura masquerading paediatric SLE. Indian J Dermatol 2015;60:313-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Kumar S, Nair S, Rajam L. Case series of pediatric systemic lupus erythematosus from Kerala: Comparison with other Indian series. Int J Rheum Dis 2010;13:391-5.  Back to cited text no. 2
    
3.
Altintas A, Ozel A, Okur N, Okur N, Cil T, Pasa S, et al. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis 2007;24:163-8.  Back to cited text no. 3
    
4.
Hazzan R, Mukamel M, Yacobovich J, Yaniv I, Tamary H. Risk factors for future development of systemic lupus erythematosus in children with idiopathic thrombocytopenic purpura. Pediatr Blood Cancer 2006;47 5 Suppl: 657-9.  Back to cited text no. 4
    




 

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