A nine years old boy with the diagnosis of borderline lepromatous type leprosy (who had been taking Dapsone 50 mg/day, Clofazimine 50mg/Every other day, Rifampicine 300 mg/Month for six months) presented with epistaxis, melena and a rash. In his physical examination he had facies leonica, a mask face appearance with also edema on his hands and feet. He also had a wide range of petechia and ecchimosis on his extremities, trunk and face. His blood count was; Hb 6,2 gr /dl, Hct 20,5%, MCV 86 fl, WBC 3600/mm3, PLT 20 000/mm3, MPV 14. His laboratory: ALT, AST, Glu, Na, K, BUN, Uric acid were all normal except LDH which were 864 mg/dl. His viral serology revealed HbsAg(-), Anti HBc IgG (+), Anti HBc IgM (-), HAV (-), Anti HAV (+), HCV (-), EBV IgG (+), EBV IgM (-), CMV IgG (-), CMV IgM (-). After withdrawal of his antileproid drugs a bone marrow aspiration was also done. In the microscopic examination an increase in megacaryoblasts was seen confirming the diagnosis of ITP, his myeloid and erythroid maturation were normal. He remained unresponsive to IVIG 1 gr/kg/day which was used for three days. After using prednisolone 2mg/kg/day for 4 weeks and stopping at the end of 6th week by decreasing the does his PLT counts were 64 000 on day 7, 140 000 on day 14 and 241 000 on day 42. He had one unit of erythrocyte in first few days of therapy. His Hct is 43,9% now and we suggested the cause of anemia as hemorrhagic diathesis and nutritional depletion.

This was found to be the first reported case of ITP together with Leprosy. Neither dapsone nor clofazimine were reported as a cause for thrombocytopenia. Rifampicine may cause thrombocytopenia by inducing antibody production against thrombocytes although the dose was too small. It was also interesting that the patient was unresponsive to IVIG therapy and gave a good response to prednisolone therapy. It is not clear if it could be a result of his leprosy.