From Petechiae to Intracerebral Hemorrhage: A Rare Progression of Pediatric Idiopathic Thrombocytopenia

A four-year-old boy presented with a four-week history of hematuria, melena, and ecchymoses on his forehead, arm, and back, as well as upper respiratory symptoms. The physical examination revealed diffuse purpura on the lips, pallor, and several hyperpigmented spots. Laboratory results showed microcytic hypochromic anemia, neutropenia, lymphocytosis, and severe thrombocytopenia. A peripheral smear revealed giant platelets and a bone marrow biopsy revealed enhanced megakaryocytes with aberrant maturation. Despite the initiation of prednisolone medication, the patient experienced generalized tonic-clonic seizures and diminished consciousness (Glasgow Coma Scale: 4/15). Neuroimaging revealed a left-sided intracerebral hemorrhage with a midline shift, requiring an immediate decompressive craniotomy. Early detection and rapid interdisciplinary management are critical for improving outcomes in these life-threatening conditions.