Introduction: Immune Thrombocytopenic Purpura (ITP) is an autoimmune disease that results in the destruction of platelets. ITP can be caused by a wide array of factors, including but not limited to viral illnesses. Herpangina is similar to Hand, Foot, and Mouth disease, with vesicles in the orpharynx but lacks the involvement of the hands and feet. This report will detail a case of ITP that resulted from a classic coxsackie virus infection: herpangina.

Case Presentation: A 3-year-5-month-old male patient was sent to the emergency room by their primary care provider for a finding of low platelets. Review of systems pertinent for 4 days of fever, sore throat, and later development of ulcers in the oropharynx. The patient had been previously seen at urgent care and tested negative for strep, but was started on amoxicillin secondary to a high Centor score of 5. The mother felt mouth ulcers were worsening despite antibiotics, which is what prompted a visit to the patient’s primary care provider. The patient’s platelets were found to be 21,000 and he was sent to the emergency room for further evaluation. On physical exam, the patient was noted to have small ulcerated vesicles on the soft palate/ posterior pharynx consistent with herpangina, as well as small petechiae on the volar hands and feet with no mucosal signs of bleeding. Repeat platelets 23,000 with no other blood cell count abnormalities. The patient’s activated Partial Thromboplastin Time was slightly low at 21.1 sec, with a normal Prothrombin/International National Ratio, normal liver function tests, electrolytes, renal function, and a negative Monospot test.

Final Diagnosis & Follow-up: Given isolated thrombocytopenia, it was felt that the most likely diagnosis is ITP secondary to herpangina. Upon consultation with hematology, the patient was discharged home with a hematology/oncology follow-up in 1 week with precautions to prevent trauma to the patient that could cause bleeding.

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