To the Editor:
A 36‐year‐old female with a past medical history of thrombocytopenia, previously classified as immune thrombocytopenic purpura (ITP), presented to the hospital with diffuse petechiae, easy bruising, bleeding gums and a mild headache. She has a history of excessive bleeding after dental procedures but denied heavy menstrual bleeding. She was diagnosed with “ITP” as a child with a baseline platelet count of 40‐60 K/μL. Previously, her work up was negative for autoimmune and nutritional disorders. Her family history included multiple generations of both genders reporting similar low platelet counts since birth. Prior evaluations included a bone marrow biopsy of a male sibling with thrombocytopenia, which demonstrated normocellular trilineal hematopoiesis with slightly increased small size megakaryocytes, normal flow cytometry; FoundationOne Liquid CDx Next Generation Sequencing testing showed multiple variants of unknown significance seen in 14 different genes including GATA2. Additionally, two younger family members had been investigated for possible ANKRD26‐related autosomal dominant thrombocytopenia though no testing was available for review in these cases. The last exacerbation of her chronic thrombocytopenia was 12 years prior during her second pregnancy for which she received intravenous immunoglobulin (IVIg) and steroids with minimal increase in her platelet count but no serious bleeding reported. Since that time, she has required no treatment; her blood counts are monitored every 6 months by her primary care doctor. Patient received the first dose of SARS‐CoV‐2 mRNA‐1273 Moderna Covid‐19 vaccine 2 weeks prior to presentation. One week post receipt the patient experienced mild headaches for which she took three ibuprofen capsules as she is allergic to acetaminophen. The headaches persisted and the patient took sumatriptan with improvement of her symptoms. She had taken ibuprofen and sumatriptan in the past with no adverse events. Also, she had a vaginal ring containing etonogestrel‐ethinyl estradiol vaginal ring placed one week prior to hospitalization.
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