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Abhigan Shrestha

and 7 more

Introduction:Varicella-zoster virus (VZV) is the causative agent of chickenpox, a viral rash that is generally benign and self-limiting, requiring minimal treatment. However, in rare cases, complications can arise. Although chickenpox is commonly associated with mild thrombocytopenia in children, severe thrombocytopenia resulting in bleeding is uncommon [1]. Immune Thrombocytopenia (ITP) is a blood disorder characterized by the destruction of platelets through immune-mediated mechanisms, leading to a decrease in platelet count below 100×10^9/L. Viral infections and live virus vaccinations are frequent triggers of ITP. It presents as acute, self-limiting episodes of bleeding, usually minor, but with the potential for intracranial hemorrhage (ICH). Compared to other causes of thrombocytopenia, ITP typically results in less severe bleeding. Diagnosis is based on clinical presentation and laboratory findings, and it is a diagnosis of exclusion [2]. The primary goal of treating a patient with ITP is to raise their platelet count to a safer level, reducing the risk of severe bleeding, particularly intracranial hemorrhage (ICH). Corticosteroids have been effectively used since the 1950s, reducing the production of anti-platelet antibodies and enhancing the clearance of opsonized platelets. Intravenous immunoglobulin (IVIG), introduced by Imbach et al., has also shown high efficacy in increasing platelet counts in over 80% of patients, with a faster onset of action compared to steroids [3].The coexistence of chickenpox and ITP presents a clinical conundrum, as the underlying mechanisms linking these conditions remain elusive. Although there are sporadic reports in the medical literature of patients developing ITP following chickenpox, the incidence of this simultaneous presentation is exceedingly rare. Furthermore, the majority of these reported cases lack comprehensive hematologic data, hindering a thorough understanding of the clinical course and management strategies.We thus present one such intriguing and rare case of chickenpox with simultaneous ITP purpura.