Muller Journal of Medical Sciences and Research

LETTER TO EDITOR
Year
: 2014  |  Volume : 5  |  Issue : 2  |  Page : 202--203

Axillary hematoma in an 18-month-old Nigerian boy with post-measles thrombocytopenia


Ibrahim Aliyu 
 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria




How to cite this article:
Aliyu I. Axillary hematoma in an 18-month-old Nigerian boy with post-measles thrombocytopenia.Muller J Med Sci Res 2014;5:202-203


How to cite this URL:
Aliyu I. Axillary hematoma in an 18-month-old Nigerian boy with post-measles thrombocytopenia. Muller J Med Sci Res [serial online] 2014 [cited 2021 Oct 16 ];5:202-203
Available from: https://www.mjmsr.net/text.asp?2014/5/2/202/135815


Full Text

Dear Editor,

Measles spreads by droplet from coughing and sneezing among close contacts or by direct spread from contaminated formites. Common risk factors for measles infection include non-immunization of children; children with immunodeficiency due to malnutrition, vitamin A deficiency, [1] acquired immunodeficiency syndrome, [2] leukemia, [3] or use of immunosuppressant drugs. [1] Though measles shares similar immunologic characteristics with smallpox, its eradication has remained elusive, especially in Nigeria where outbreaks are recorded almost annually. In addition to other clinical features, measles can affect the hematologic system resulting in thrombocytopenia and disseminated intravascular coagulopathy. Therefore, we report the case of an 18-month-old boy who presented with an axillary swelling and diagnosed with measles during the 2013 epidemic. A week after appearance of the rash, his mother noticed swelling on the left axilla, which was initially the size of a peanut, increasing over a week. There was no history of fever, fall, or trauma to the site, and no similar swelling was observed at other sites; there was no history of any overt bleeding from any site. The patient was not immunized for measles and had no other risk factor for measles. He had normal anthropometry for sex and age. There was no organ enlargement on abdominal examination but there was massive swelling with a shiny surface, involving the left axilla [Figure 1]. It was fluctuant and tender, and diagnosis of subcutaneous abscess was made. The swelling was incised but it drained blood [Figure 2]. This necessitated evaluating for bleeding diatheses. However, the prothrombin time (PT), activated partial thromboplastin time (aPTT), and full blood count were not remarkable except for the platelet count, which was low at 60,000/mm 3 (150,000-400,000 mm 3 ). Therefore, the diagnosis changed to axillary hematoma with thrombocytopenia. The platelet count normalized spontaneously and the swelling resolved by the end of the first week of admission.{Figure 1}{Figure 2}

Complications in measles infection are more likely to occur in individuals younger than 5 years or older than 20 years. Involvement of hematologic system is rare and complications such as hemorrhagic measles, purpura fulminans, hepatitis, disseminated intravascular coagulation (DIC), and thrombocytopenia have been reported. [4]

Though thrombocytopenia has been associated with measles infection and with measles, mumps, and rubella (MMR) vaccination, especially in those given in the second year of life, its exact mechanism is not completely understood. However, based on observed elevated IgG auto-antibodies detectable in some patients, auto-immunity might be a possible cause. [5] Thrombocytopenia, though rare in measles, [5] may cause significant bleeding. Therefore, full blood count with platelet count should be considered in evaluating children with measles. This index case had no purpura, which may be attributed to the level of his platelet count. Spontaneous skin bleeds may occur at platelet count below 20,000/L. Inability to link other cause such as trauma to the site of hematoma makes the association with thrombocytopenia a possibility but isolated hematoma remains unclear. However, the thrombocytopenia resolved without active intervention.

References

1Chen SS. Measles. 2011. Available from: www.medscape.com/article/966220-overview [Last accessed on 2013 Jul 24].
2Gowda VK, Sukanya V, Shivananda. Acquired immunodeficiency syndrome with subacute sclerosing panencephalitis. Pediatr Neurol 2012;47:379-81.
3Breitfeld V, Hashida Y, Sherman FE, Odagiri K, Yunis EJ. Fatal measles infection in children with leukemia. Lab Invest 1973;28:279-91.
4Perry RT, Halsey NA. The clinical significance of measles: A review. J Infect Dis 2004;189 Suppl 1:S4-16.
5Arakawa Y, Matsui A, Sasaki N, Nakayama T. Agranulocytosis and thrombocytopenic purpura following measles infection in a living-related orthotopic liver transplantation recipient. Acta Paediatr Jpn 1997;39:226-9.