Infant with Paediatric Astrocytoma and the “Rescuing Urgency” of Severe Acute Thrombocytopenia: Causally Related or Coincidental?

Abstract

Although immune thrombocytopenic purpura (ITP) has been associated with solid tumors among adults, this coexistence is exceedingly rare in children. We present an infant with a brain tumor associated with severe acute thrombocytopenia (SAT), which has been very rarely reported in association with pediatric brain tumors.

Case Presentation:

A 7-month-old male twin presented with a 2-day history of fever and a 1-day history of right subconjunctival haemorrhage that had progressed to involve the left eye. Initial investigations showed severe thrombocytopenia and a provisional diagnosis of ITP was made. He was managed conservatively but he developed a forehead swelling and subcutaneous bruising with minimal improvement in thrombocytopenia. Three days later he had multiple episodes of vomiting, worsening subconjunctival haemorrhage and somnolence. Transfontanelle ultrasound revealed intracranial haemorrhage and computed tomography brain imaging demonstrated left-sided mass effect. He was admitted to the Intensive Care Unit (ICU) and dexamethasone, ceftriaxone, omeprazole and apheresed platelet concentrate were given. Later he was transferred to a specialized neurosurgical facility where he underwent a craniotomy with mass excision of intra-operative astrocytoma (biopsy confirmed). He had a second craniotomy on account of residual tumor tissue revealed on brain magnetic resonance imaging 48 hours after the first surgery. He was subsequently discharged 9 days post-2nd craniotomy after other supportive management and optimisation. Investigations showed dramatic normalization and elevation of platelet count at post-discharge review. This was sustained throughout the follow-up clinic during the 12-week follow-up care with no recurring thrombocytopenia. Patient continued to record significant improvement in the motor function throughout the follow-up clinic.

Conclusions:

This case highlights severe acute thrombocytopenia as a potential early clinical clue to an underlying intracranial pathology in infants. While a paraneoplastic immune mechanism is hypothesized, the association may also represent a coincidental coexistence. Further studies are required to clarify this relationship