1. History of Present Illness

A 52 y.o. man presented to the ER in 1999 with gum bleeding and widespread petechiae.

Past medical history dates back to 1971 when he was diagnosed with ITP. He did not respond to steroids and subsequently underwent a splenectomy with a good platelet response; platelet counts have been normal ever since and he has had no bleeding.

In 1998 he developed a mild autoimmune hemolytic anemia with a cold agglutinin. Work-up was negative for lymphoproliferative disorder, incl CT of chest, abdomen, and pelvis, LN and BM biopsy.

Recently, he noticed bleeding gums and epistaxis. He also noticed “red dots” on his legs, and a blood blister on his lip. He denied hematuria or GI bleeding. He recently noted a lump in his left wrist.

He denied headache or neurologic symptoms, pain, difficulty with breathing or swallowing. He had no constitutional symptoms, no fever or chills, no sick contacts, and no viral prodrome.