Secondary Immune Thrombocytopenic Purpura Presenting as Severe Epistaxis Associated with Maxillary Sinus Malignancy: A Case Report

Abstract

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterised by isolated thrombocytopenia (platelet count <100 × 10⁹/L) and bleeding manifestations. While primary ITP is common, secondary ITP associated with solid organ malignancies is a rare and challenging clinical overlap. A 25-year-old male with a known history of immune thrombocytopenic purpura presented with severe recurrent epistaxis associated with facial swelling. Evaluation revealed thrombocytopenia without abnormalities in coagulation parameters, consistent with ITP. Due to persistent bleeding and atypical local symptoms. Imaging of the paranasal sinuses revealed a mass lesion involving the maxillary sinus, and histopathological examination confirmed malignancy. Early recognition of secondary causes of ITP can significantly influence treatment strategy and prognosis. This case emphasises the necessity of investigating secondary causes of thrombocytopenia when patients present with atypical local symptom that severe epistaxis may represent the initial manifestation of a complex interaction between haematological and malignant processes.