Unusual clinical findings in thrombotic thrombocytopenic purpura


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A 42-year-old Vietnamese woman was admitted to hospital with fever, weakness, aches, jaundice and neurological impairment. She had severe bruising in a linear pattern along the ribs on either side of the spine (figure). She had been treated with Cao-gio a few days earlier. Laboratory tests showed anaemia, elevated lactate dehydrogenase level, schistocytosis, severe thrombocytopenia (platelet count 1 × 109/l) and renal dysfunction. Thrombotic thrombocytopenic purpura (TTP) was diagnosed. Plasmaphaeresis was performed in addition to immunosuppressive therapy with corticosteroids. The patient’s platelet count and renal function improved gradually.

There are few reported cases of complications of Cao-gio. Cao-gio – which means ‘to scrape the wind’– is an ancient practise of lubricating the skin with oils then rubbing it with a coin to draw off excess wind from the body. In traditional Chinese medicine, ‘wind-illness’ is believed to contribute to fever, muscle aches and low energy. The back, ribs and chest are common sites of application. The degree of redness produced by the rubbing is taken to reflect the severity of the wind illness. Marks induced by Cao-gio in children have often been mistaken for evidence of child abuse. In our patient, the marks faded a few days after completion of treatment for TTP.