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Write-up: Information has been received from a physician at health conference, concerning her 15 year old daughter with a history of bleeding gums (attributed to orthodontic braces) previous 7 days, menstruation heavier 7 days earlier, slight sore throat approximately 1 week prior, and infectious mononucleosis showed possible acute infection, but seroconversion did not occur until 05-FEB-2007, possibly delayed by prolonged steroid treatment. On 03-OCT-2006, the patient was vaccinated with first dose of HPV vaccine. No reaction occurred. On 24-NOV-2006, the patient was vaccinated with second dose of HPV vaccine (lot # not reported), one month after the first dose. No reaction occurred. On 12-DEC-2006, poliovirus vaccine boosterix injection was given. A 5cm bruise developed within 4 hours. On 12-DEC-2006, the patient was hospitalized with a platelet count greater than 5. Signs included: 4 cm hematoma at the site of immunization left upper arm, few petechiae on lower abdomen, no hepato-splenomegaly. Provisional diagnosis of immune thrombocytopenia (ITP) was made. The patient was treated with Prednisone 75 mg stat, 3 weeks of 50 mg Prednisone, followed by decreasing dose over the next month. By 29-JAN-2007, the patient''s platelet count slowly returned to normal. The physician commented: "This is case of ITP, probably due to infectious mononucleosis, but diagnosed 18 days after the second dose of HPV vaccine (symptoms started approximately 10 days after the vaccine). I am hopeful it was due to Glandular fever but an interesting co-incidence and an unusual presentation of "IW." Additional information has been requested.
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