Ovarian Torsion-A Rare Presentation in Immune Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP) is an immune-mediated disorder that is caused by antibody mediated platelet destruction with a normal bone marrow. Bleeding manifestations are mostly muco-cutaneous and mild. Intra-ovarian bleeding leading to enlargement and subsequent torsion is extremely rare and only one case has been reported so far in literature. We describe a case of a 14 year old girl who presented in Medical Emergency with abdominal pain, vomiting and low grade fever. She was clinically observed for gastroenteritis as all her investigations were normal, except for ultrasound which depicted a mildly enlarged polycystic left ovary. On further continuation of symptoms, a repeat scan showed heterogeneous complex left adnexal mass. Color Doppler and MRI confirmed ovarian infarction. She was prepared for laparotomy but had very low platelet counts on pre-anesthetic checkup. With hematology consultation and bone marrow biopsy, a diagnosis of immune thrombocytopenic purpura was made. With initiation of prednisolone her counts improved dramatically and later laparotomy was done after 7 days. Histopathology specimen of ovary confirmed stromal hemorrhage and areas of necrosis. Intra-ovarian bleeding, possibly because of very low platelet count, resulting in an enlarged ovary and subsequent torsion might be the association between these two clinical entities.