The unsuspected danger of strawberries: Severe thrombocytopenia during pregnancy

Background : Immune thrombocytopenia (ITP) is a disorder marked by an immune-mediated response affecting platelet’s destruction or production. While it is extremely rare, some fruits such as strawberries, can potentially contribute to thrombocytopenia usually due to an allergic reaction. The mechanism likely involves an immunoallergic response, where specific fruit antigens stimulate the production of platelet antibodies and generate low platelet count in the blood. During pregnancy, the immune system undergoes significant adaptations, potentially heightening susceptibility in individuals with underlying immunologic disorders. Case description : We report novel and particular case of severe ITP in a pregnant woman triggered by strawberry consumption in the context of quiescent adult-onset Still’s disease (AOSD). The patient presented with epistaxis, itching and ecchymoses temporally linked to strawberry ingestion. Laboratory findings confirmed severe thrombocytopenia and positive platelet antibodies, supporting an immunoallergic mechanism. Other causes were excluded. Treatment included corticosteroids (CSs), azathioprine (AZA) and dietary avoidance, leading to complete recovery. Conclusion : This original case is both interesting and enigmatic, raising awareness of the immunoallergic investigations’s contribution to diagnostic and therapeutic decisions.