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Mr. P.P., 36 year old patient, reported to the clinic for complaints of petechial hemorrhage that developed on the extremities while playing football. There was swelling of the legs as well. Before this episode, he used to suffer from pain in the legs and knees while playing.
Due to the marked petechial patches, the patient's wife consulted their local physician who advised them to get some blood investigations done. The local surgeon who did the Bone marrow aspiration diagnosed it as autoimmune thrombocytopenic purpura. The patient was immediately put on immunosuppressive drugs; on a high dose of 60 mg/day. At this time, the Platelet count was 35000/cumm. In spite of the heavy medications, there was further deterioration in the platelet count. At this juncture, on 30/6/03 the patient consulted us.
The patient related the above complaints to us in detail. When we asked if he was going through any tension, he said he was tensed because of his son who was quite intelligent but had failed in his Higher Secondary Board examinations. Besides this, he was going through a lot of financial stress.
On further enquiry, the patient said that his father had been a very strict man and wanted discipline in work. The patient had to struggle a lot in his childhood to complete his studies. His father used to scold him and used to beat him. He never used to like this and from within, he felt very angry but he never expressed his anger and kept all these things in his mind even till date. To add to the misery, his mother was also short-tempered though she had a good nature. As he was the only child, so he felt quite lonely and he wished he had siblings. When in a sad mood, he listened to sad songs and he would feel better.
As a child, he was afraid of darkness, of coming down from heights, and he also used to get scared while reading horror stories. He had the habit of biting his nails and talking in his sleep. He was sensitive by nature and felt angry internally if somebody said something wrong. If he would get angry, he would not be able to cool down fast. If somebody would console him, he would like it. He was very particular and liked things in proper place and in a systematic way.
Cravings: Sweets, Sour things, Chalk, Eggs, Mutton
He was sensitive to heat in general and would not be able to tolerate being in direct sunlight- it would give him headaches.
Sleep: Sound, can sleep easily
Thirst: Normal
Stools: Hard; constipation after taking fish, coffee
Past History:
Renal calculi (right sided)
Alopecia areata, which had been treated with local ointments and since then, the alopecia had not recurred.
Parotitis at the age of 11 years
Family History:
Father: Hypertension, Diabetes mellitus, Asthma, Coma
Mother: Diabetes mellitus, IHD
Aunt had throat Cancer
Examination findings:
Weight: 60 kg
Dryness of the tongue
Hypopigmentation and hyperpigmentation on the face
DNS to the right
Respiratory system: Rhonchi
C.V.S: NAD
Blood pressure: 110/90 mm of Hg
Based on the above history, he was prescribed Sulphur 0/3 for his complaints. 2 weeks later, his platelet count was rechecked and it was found to be better than the last time. The treatment was continued on similar lines and gradually his count started progressing towards normal. His complaints of cramps in the legs also improved significantly. His counts have been tabulated below:
| Date | Platelet count |
| 2/6/03 | 35000/cu mm |
| 5/7/03 | 84000/cu mm |
| 12/7/03 | 96000/cu mm |
| 5/8/03 | 1,42,000/cu mm |
During the treatment patient had some injury and he had taken some medicine on his own, which caused the platelet count to drop to 20000. Again, patient was put on Sulphur 0/3 and his platelet count reached 1,50,000/cu mm. Thus, the patient's acute stage of Auto-immune Thrombocytopenic Purpura was successfully treated and he stopped getting any more petechial hemorrhages.
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