Spontaneous Lingual Bleeding and Intracerebral Hemorrhage in a Young Adult with Immune Thrombocytopenia (ITP): A Rare Case Report and Brief Recent Update on Treatment.

Abstract

Introduction: Immune thrombocytopenia (ITP) is an autoimmune condition characterized by reduced platelet counts due to increased peripheral destruction and impaired platelet generation. An estimated incidence of ITP is 2 to 5 cases per 100,000 individuals in the general population. While mucocutaneous bleeding is common, life-threatening complications, such as spontaneous lingual hematoma and intracerebral hemorrhage (ICH), are extremely rare. Rapid progression of lingual haematomas might compromise airway function and necessitate immediate medical intervention. It is well established that most patients with ITP respond to first-line therapy; however, severe bleeding events, such as intracerebral hemorrhage, occur in less than 1% of cases and are associated with significant morbidity and mortality.

Case presentation: A 21-year-old male with a 6-month history of chronic ITP and poor compliance with therapy presented with a 2-day history of progressive reddish discoloration and swelling of the tongue. The clinical examination revealed stable vital signs and a remarkable general and systemic evaluation. The relevant blood routine showed a critically low platelet count at 8×103/μL, with normal coagulation parameters. No other bleeding manifestations were noted. Four hours after admission, the patient developed generalized tonic-clonic seizures and altered sensorium. Computed tomography (CT) of the head revealed an ICH. He was managed with single- donor platelet transfusions, intravenous anti-epileptics, pulse corticosteroid therapy, eltrombopag, and supportive care. The patient demonstrated a favorable clinical response, characterized by a rising platelet count and resolution of symptoms. He was discharged in stable condition with counseling on therapy adherence.

Conclusion: The present case emphasizes the rarely yet life-threatening complication of inadequately managed ITP, such as spontaneous lingual hematoma and intracranial haemorrhage. It highlights the vital significance of therapy adherence and timely interdisciplinary intervention to avert disastrous consequences. Timely detection and intervention are crucial for positive outcomes in these intricate cases.