Acute immune thrombocytopenic purpura following oral polio vaccination

• Child
• immune thrombocytopenic purpura
• oral polio vaccination

To the Editor

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts due to increased destruction and impaired platelet production, partially related to the presence of autoantibodies directed toward platelet-membrane antigens [1, 2]. ITP may also occur after rubella, rubeola, chickenpox or live virus vaccination [3]. The association between oral polio vaccine and ITP is very rare [3]. In the literature, there is only one reported case of a child with ITP after oral polio vaccine [4]. In this article, we reported one ITP case due to oral polio vaccine.

A 3-year-old male was brought to the emergency department with the complaint of petechial rash, continued for three days and appeared 10 days after the administration of oral polio vaccine. The personal and family histories were unremarkable for bleeding disorders and events. Moreover, recent history of infectious disease was not described. The physical examination of the patient was normal except the presence of petechial rash on upper, lower extremities and trunk. The laboratory examinations included complete blood count, prothrombin time, partial thromboplastin time, serum electrolytes, liver and renal function test, brucella and salmonella serology, were found to be normal except severe thrombocytopenia (platelet count 5.000/mm³). No blastic or atypical cell was found on blood smear examinations. Platelet was not detected in smear. Considering the complete clinical examination and investigations, a final diagnosis of ITP was made. IVIG (0.5 g/kg/day for 2 days intravenously) was given. After 24 hours of treatment, the platelet count increased to 42.000/mm³. Normal platelet count was achieved on the seventh day of the treatment on which platelet count was measured as 189.000/mm³. In the follow-up the platelet count of the patient was within normal levels and the patient diagnosed as acute ITP.

ITP after vaccination with live attenuated measles vaccine was first reported in the mid-1960s [5]. Individual case reports and series have subsequently been published describing thrombocytopenia after vaccination against measles, mumps and rubella (MMR); smallpox, diphtheria, tetanus, pertussis, hepatitis, and influenza and pneumococcal infection [5]. Between 1992 and 2007, only 115 cases of ITP after vaccination were reported in Canada, 77 of which (74.7%) occurred after MMR, 28 after diphtheria, tetanus and pertussis or diphtheria, tetanus and acellular pertussis vaccine, and 10 after varicella vaccine. Most of the cases were mild and did not give rise to severe complications [5]. The phenomenon is mainly explained by an antigenic similarity of parts of the vaccine and the platelet surface proteins which lead to antibody-mediated destruction of platelets [4]. Jin et al. [3] reported the first case of ITP, which was triggered by an oral polio vaccine and caused purpura. In their report, a complete hemogram revealed severe thrombocytopenia with platelet count as low as 13.000/mm³ and a final diagnosis of ITP was made. Here we report the second case with acute ITP that was seen after oral polio vaccine.

In conclusion, our case showed that acute ITP might be seen after oral polio vaccine. Therefore, we suggest that aside from a recent infectious disease and oral polio vaccine should be inquired in children with acute ITP.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.