# Spontaneous Peritoneal Hemorrhage and Anemia: A Rare Case Report of Immune Thrombocytopenic Purpura

## TL;DR

A 14-year-old girl with immune thrombocytopenia experienced rare spontaneous peritoneal bleeding and anemia, successfully treated with IVIG and blood transfusion.

## Contribution

This case report highlights a rare complication of ITP—spontaneous peritoneal hemorrhage—and its successful management.

## Key findings

- The patient showed severe thrombocytopenia and normocytic anemia with peritoneal hematic effusion.
- Treatment with IVIG and blood transfusion led to a gradual recovery of platelet count and hemoglobin.
- Spontaneous resolution of peritoneal hemorrhage occurred without further intervention.

## Abstract

Immune thrombocytopenia (ITP) is characterized by isolated thrombocytopenia manifesting with mucocutaneous bleeding symptoms, generally mild to moderate. The presence of severe symptoms or complications is rare but can be life-threatening and should be promptly diagnosed and treated.

We present the case of a 14-year-old female presenting with abdominal tenderness and signs of peritoneal irritation and found to exhibit petechial rash in the buccal mucosa, scant petechiae, and superficial ecchymosis in both arms and legs on physical examination. Laboratory evaluation revealed severe thrombocytopenia and normocytic anemia. Abdominal ultrasound showed a significant peritoneal hematic effusion. The diagnosis of ITP with spontaneous peritoneal hemorrhage was made, and she was treated with intravenous immunoglobulin (IVIG) and antibiotic therapy, as well as one packed red blood cell transfusion because of worsened anemia on re-evaluation. A gradual rise in platelet count and hemoglobin was observed, as well as a gradual resolution of the peritoneal hemorrhage, with no further therapy.