Case 325 -- A 2-year-old boy with prolonged oral bleeding

Contributed by Hina A. Sheikh, MD and Franklin Bontempo, MD
Published on line in October, 2002


PATIENT HISTORY:

A 2-year old boy was brought to the emergency department by his mother for oozing blood from his mouth following a fall nearly 6 hours ago. His mother related that he tended to bleed for prolonged periods from his immunization sites, but there was no history of bruising or hematomas. The patient was on antibiotics for a recent ear infection. There was no known family history of a bleeding disorder.

PHYSICAL EXAMINATION:

GENERAL: Alert, in no apparent distress, development appropriate for age

HEENT: Two small lacerations on the inside of lower lip, oozing blood

Remainder of exam within normal limits (notably, no petechia, bruises, joint swelling)

INITIAL LABORATORY TESTS:

DIFFERENTIAL DIAGNOSIS:

ADDITIONAL WORKUP:

WHAT IS THE MOST LIKELY CAUSE OF PROLONGED BLEEDING IN THIS CASE?

FINAL DIAGNOSIS


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