Acquired platelet dysfunction with eosinophilia in two patie
Acquired platelet dysfunction with eosinophilia (APDE) is a transient bleeding disorder characterized by spontaneous bruising in a healthy person. Spontaneous ecchymosis appears in 100% of patients with APDE.1 Other symptoms include epistaxis, gum or oral bleeding, gastrointestinal bleeding, hematuria, bleeding of the genital organs, subconjunctival hemorrhage, and excessive bleeding after tooth extraction.

The diagnosis of APDE requires three elements:
(1) clinical manifestation with spontaneous ecchymosis on the trunk or extremities,
(2) hemogram showing eosinophilia, and
(3) platelet dysfunction.

Here presented two case reports in both cases complained of multiple spontaneous cutaneous bruises on their bilateral lower limbs for weeks. Neither gastrointestinal manifestation, such as abdominal pain, weight loss, diarrhea, and vomiting, nor skin rash or itching over the perineal area was observed. Upper respiratory tract infections were noted before the episodes. Neither patient had a bleeding tendency or a family history of any bleeding disorder. The parents of both patients reported histories of allergic rhinitis. Physical examinations showed no abnormal findings, except for multiple ecchymoses over their bilateral lower limbs (Fig. 1A, B).
Laboratory investigations revealed prolonged collagen/epinephrine (C/Epi) and collagen/adenosine diphosphate (C/ADP) closure times. The results of stool ova and parasite examinations were negative. Bone marrow examinations performed during admission revealed an increased infiltration of mature eosinophils and its precursors. Mebendazole was prescribed to both patients for 3 days. During the follow-up in the outpatient department, their absolute eosinophil counts and platelet function closure times gradually recovered to within the normal range in 2 months. In 6 months, their bruises were also diminishing.

Source :