Clinical Observation and Etiological Aspect on the Thrombocytopenic Purpura after Rubella Toyoji SODA, Masashi KAWANO, Toshihiko KATO*, and Takeshi SH

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1 Clinical Observation and Etiological Aspect on the Thrombocytopenic Purpura after Rubella Toyoji SODA, Masashi KAWANO, Toshihiko KATO*, and Takeshi SHIGEMATSU**, Rubella is an acute viral infectious disease characterized by a skin rash and generalized lymph node swelling, particularly of the postauricular, suboccipital, and cervical lymph nodes. Rubella is considered a mild and common disease in children and young adults. Complications caused by rubella such as arthritis, encephalitis and thrombocytopenic purpura have been reported since the 1920s. The most important otolaryngological complication is thrombocytopenic purpura that develops severe epistaxis. Thromobocytopenic purpura following rubella was first described in 1929 by Pitten. A 17-year-old boy was admitted to our hospital, who suffered from thrombocytopenic purpura following rubella with severe epistaxis and petechial bleeding. The peripheral platelet count was only 4000/cmm. Bone marrow examination showed that megakaryocyte had vacuoles in cytoplasm but its platelet formation was normal. Bleeding time was uncountable but coagulation time was within normal range. Rubella antibody titer in his serum was high. Platelet function was normal. Hemorrhagic diathesis was recovered with corticosteroid therapy and platelet transfusion. Severe epistaxis ceased in a few days and, at the same time, the peripheral platelet count rapidly increased. After 22 days, it was recovered within normal range. The serious thrombocytopenia in this patient was regarded to be caused by rubella. Department of Otorhinolaryngology, School of Medicine, Fukuoka University, Fukuoka, Japan Department of Internal Medicine, Matsuyama Red-Cross Hospital, Matsuyama, Japan

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3 耳 348 表1 鼻 と 臨 床 入院時検査成 績 生 化学,一 般 検 査 所 見 末梢血液所見 骨髄所見 凝固系所見 図3 骨 髄 巨核 球 空 胞 形 成(矢 印) 24巻3号

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5 Natural history of postnatal rubella. Pattern of virus excretion and antibody response. (Modified from Cooper, L. Z., and Krugman, S.: Arch. Ophth. 77: 434, 1967.)

6 1) GREGG, N. M.: Congenital cataract following German measles in the mother. Trans. Ophthal. Soc. Aust. 3: 35, ) PITTEN, T.: Uber einen Fall von symptomatischem Morbus Werlhof nach ROtein. Arch. Kinderheilk. 86: 114, ) BAYER, W. L.: Purpura in congenital and acquired rubella. New. Eng. J. Med ) MORSE, E. E.: Thrombocytopenic Purpura Following Rubella Infection in Children and Adults. Arch. Intern. Med. 117: 573, ) KOMOROWER, G. M, et al.: Prognosis in idiopathic thrombocytopenic purpura of childhood. Arch. Dis. Childhood. 29: 502, 1954.

7 10) FERGUSON, A. W.: Rubella as a cause of Thrombocytopenic purpura. Pediatrics 25 13) MYLLYLA, G., et al.: Interaction between human blood platelets, viruses and antibody. Clin. Exp. Immunol. 4: 323, ) HARKER, L. A, et al.: Thrombokinetics in Man. Journal of clinical investigation. 48: 963, ) KRUGMAN, S, et al.: Clinical Manifestation of postnatal and Congenital Rubella. pura following Rubella. JAMA. 193: Arch. Ophth, 77: 434, ) LUSCHER, J. M., et el.: Idiopathic throm bocytopenic purpura in childhood. J. Pediat, 68: 971, 1966.

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