Wet purpura: a sinister sign in thrombocytopenia

Description

A previously healthy, 38-year-old man presented with non-pruritic rash over his legs and trunk noticed 2 hours back. Examination revealed non-palpable purpura over the limbs and trunk. There was multiple 'wet purpura' over the buccal mucosa, palate and tongue (figure 1A). He had mild pallor and direct ophthalmoscopy showed bilateral fundal haemorrhage with sparing of macula. There was no organomegaly or palpable lymphadenopathy. His investigation showed haemoglobin 125 g/L, white blood cell 8.7x10⁹/L, platelet 7x10⁹/L and normal peripheral smear. He was treated with intravenous methylprednisolone (1 g once a day x3 days) and received one single donor platelet (SDP) transfusion. His bone marrow aspirates showed increased megakaryocytes and no atypical cells or excess of blast; overall picture was consistent with immune thrombocytopenia (ITP). His platelet count on day +3 was 55x10⁹/L. He was put on oral prednisolone (1 mg/kg/day). On day +7, he was asymptomatic with no evidence of any mucocutaneous bleed (figure...

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