Spontaneous Oral Purpura in Immune Thrombocytopenia

A 76 year old man presented with sudden-onset blood-filled blisters on the tongue, without prior trauma or systemic bleeding symptoms. Examination revealed hemorrhagic bullae on the oral mucosa and purpura on the limbs. Laboratory tests confirmed severe thrombocytopenia (platelet count: 3,000/mm³) with normal viral panels and elevated megakaryocytes on bone marrow biopsy. A diagnosis of primary immune thrombocytopenia was made. Treatment with a tapering course of prednisolone led to resolution of mucocutaneous lesions and normalization of platelet count at 12 weeks. Oral purpura may be an initial manifestation of immune thrombocytopenia in rare cases.

A 76 year old man presented with sudden-onset blood-filled blisters on the tongue, without prior trauma or systemic bleeding symptoms. Examination revealed hemorrhagic bullae on the oral mucosa and purpura on the limbs. Laboratory tests confirmed severe thrombocytopenia (platelet count: 3,000/mm³) with normal viral panels and elevated megakaryocytes on bone marrow biopsy. A diagnosis of primary immune thrombocytopenia was made. Treatment with a tapering course of prednisolone led to resolution of mucocutaneous lesions and normalization of platelet count at 12 weeks. Oral purpura may be an initial manifestation of immune thrombocytopenia in rare cases.