Severe Thrombocytopenic Purpura as a Complication of Cat Scratch Disease

A 6-year-old previously healthy girl presented with a 2-day history of extensive bruising and petechiae. She had an intermittent high-grade fever (101 F) over the previous 2 weeks but had been afebrile since the onset of hemorrhagic symptoms. She had no other constitutional symptoms. Her medical history was noncontributory. She had a positive history of cat contact and her only medication was acetaminophen for fever. She lived with her parents and 2 sisters, none of whom were ill. Physical examination revealed a playful cooperative child with extensive bruising and petechiae over arms, legs, trunk, and face. There were no mucous membrane bleeding and no retinal hemorrhages. Her left submandibular and anterior cervical nodes were mildly enlarged and nontender. She had good oral hygiene, her tympanic membranes were normal, and there was no evidence of scalp infection. She did not have pallor or hepatosplenomegaly. The remainder of the examination was essentially normal.