Primary immune thrombocytopenia (ITP) is the most frequent immune Blood pathology. In children, the incidence of newly diagnosed ITP is 4-6 per 100,000 children per year, of which about 30% develop persistent ITP and 5-10% develop chronic ITP.
Modern therapies cannot achieve complete cure of ITP, but remission of varying duration or a state of clinical compensation is possible (https://itpurpura.ru/news/klinicheskie-rekomendaci-po-itp-dlya-detei-i-vzroslyh). The main goal of ITP therapy is to control the hemorrhagic syndrome, but it usually fails to restore normal platelet counts. This article shows a case of treatment of immune thrombocytopenia with the homeopathic preparation Arum triphyllum.
Primary appointment 28.09.23, patient S.A., a boy of 10 years old.
Complaints: Weakness, rapid fatigue (3). Grinding of teeth in sleep (2). Fear of dogs (2). Sweating of the head during sleep (3).
Past medical history:
In May 2023, suffered from acute respiratory viral infection, with an increase in body temperature up to 40 C, received treatment – Nurofen, ambrobene, lysobact, IRS-19. The first nosebleeds appeared in early June 2023, which were not given importance.
In August subcutaneous hemorrhages appeared. In early September, a profuse nosebleed appeared. Applied to the pediatrician, in the general blood test from 04.09.23 noted a decrease in platelets to 13×109/l. He was referred for hospitalization in the oncology department of the Irkutsk Regional Children’s Clinical Hospital.
From 04.09.23 to 12.09.23 pulse therapy with methylprednisolone 30 mg/kg was carried out. On the background of the treatment hemorrhagic syndrome was stopped, partial hematological response was achieved – 11.09 the number of platelets was 55×109/l.
He was discharged under outpatient observation at the place of residence. 13.09 – subcutaneous petechiae appeared, in OAC the platelet count decreased to 31*109/l. 15.09 – further decrease of platelet count to 23*109/l. The patient was re-hospitalized to the oncology department, where from 15.09 to 27.09 he received the second course of pulse therapy with methylprednisolone. He was discharged with a platelet count of 188*109/l. The third course of methylprednisolone pulse therapy was recommended 3 weeks after discharge on 19.10.23.
Life history
This child is from 2 wanted pregnancies, 1 delivery. Emergency cesarean section at 38-39 weeks, weak labor. Umbilical cord entanglement, asphyxia. Apgar 5/7 points. Vaccinated according to the calendar. At the age of 1 year 3 months he had pneumonia, treatment in hospital.
At the age of 2 years of rosella, chicken pox. Often was ill with acute respiratory infections with fever up to 38C from 3 to 7 years old. During this period he was sick several times, including purulent tonsillitis, was treated with antibiotics.
From 7 to 9 years of age, he practically did not suffer from acute respiratory viral infections, there were episodes of one-day fever up to 37.5C without catarrhal phenomena and he did not receive treatment. There were no traumas and surgeries.
Family history: On maternal line great-grandfather had tuberculosis.
Emotional state: By character kind, responsive. Weepiness, resentfulness, if separated from the phone, computer. Sensitive to criticism, remarks (2), especially about studies. In an outburst of crying, can shout loudly (3), rarely manifests autoaggression – can hit himself on the head (2), consolation is not accepted. Self-calm within an hour. Hysterical behavior is associated with deprivation of gadgets or schoolwork.
General symptoms: Desire to be in a cool room, lie on a cold floor (3), with decreased platelets, feels like a sudden hot flush without sweating (3). No food modalities have been identified.
Observation: The child has an open personality, behaves calmly, is balanced. Picks his lips throughout the admission (4).
Physical examination: Skin is clean. Lymph nodes are not palpated. Liver and spleen within normal limits. Enlargement of the palatine tonsils 1 st. Lungs, heart without peculiarities. Lips are dry, cracked (4), deep, bleeding (4).
Addendum to anamnesis after examination: Dry lips since infancy, last 3 years cracks appeared. Use creams or hygienic lipstick constantly. In winter 2023 – there was redness around the mouth in the type of “red fringe”.
Repertorization (Vithoulkascompass 2023 computer program):
Twelve symptoms were taken (strategy – totality of symptoms):
- MIND – Sensitive, oversensitive – criticism (2)
- MIND – Shrieking, screaming, shouting (3)
- MIND – Strikes – head his (2)
- MIND – Fear – dogs, of (2)
- FACE – Picking – lips (4)
- FACE – Chapped – lips (4)
- FACE – Bleeding lips (4)
- FACE – Discoloration – red – mouth – around (1)
- HEAD – Perspiration – scalp – night (3)
- Teeth – Grinding during sleep (3)
- GENERALITIES- Cold – amel. (3).
- GENERALITIESl – Heat – flushes of (3)
Flat repertorisation (Fig.1) brought Natrium muriaticum to the first place in terms of totality of symptoms and degrees, which covers 8 out of 12 symptoms. Arum triphyllum ranks second with 7 out of 12 symptoms covered.
Figure 1 Flat repertorisation
The Vitulkas Expert System (VES, Fig. 2) ranked Arum triphyllum first (Fig. 3), highlighting the key symptoms of the drug – “lip picking” and “chapped lips”. At the same time, Natrium muriaticum is ranked only 8th in the VES score (Fig.4), with the key symptom “chapped lips”. At the same time Natrium muriaticum is not marked in the symptom “picks lips”. Second in the expert system is Tuberculinum bovinum (Fig.5), which overlaps only mental symptoms without affecting physical symptoms.
The most prominent symptom detected on admission appeared to be the patient’s lip picking behavior, and then examination revealed the condition of the lips (Fig.6) – deep, bleeding cracks. These symptoms revealed a picture of Arum triphyllum.
Prescription: Arum triphyllum 30CH, 2 times a day, 1 grain dissolved in 40 ml of water, divided into 2 doses.
Figure 2. Repertorization using the VES module (Vitulkas Expert System)
Figure 3 Symptoms of Arum triphyllum
Figure 4 Symptoms of Natrium muriaticum
Figure 5 Symptoms of Tuberculinum bovinum
Figure 6 Lips condition at 09/28/23
Observation
The platelet count at the time of the initial consultation on 09/28/23 was 188×109/L (after pulse therapy with methylprednisolone the previous day). Since immediately, after the first pulse therapy in early September, the platelet count dropped sharply to 13×109/l, it was expected that this index would decrease significantly in a few days.
Blood analysis of 10/02/23 showed a decrease in platelet count to 32×109/l, confirming our assumption. Lips, still, remained dry, with deep cracks. It was decided to increase the frequency of Arum triphyllum 30CH intake up to 3 times a day.
On this background blood analysis of 10/12/2023 showed an increase in platelet level up to 59*109/l. Until 12/12/2023 platelet level fluctuated within 62-88*109/l. The lips became much less cracked (Fig. 6), while the boy continued to persistently pick his lips, tearing off the crusts formed on the wounds.
Figure 6 Lips condition at 12/12/23
On 12/12/23, the child developed a body temperature up to 38C, without sweating, without chills, with thirst and pain in the throat, first on the right, then on the left, which increased when swallowing. Repertorisation was performed (Fig.7), based on which the expert system put Lycopodium in the first place and Arum triphyllum in the second place.
Figure 6 Repertorisation 12/12/23
Both of these drugs have the key symptom: “Throat – Pain – right – extending to left”. It was recommended to increase the frequency of taking Arum triphyllum 30CH – every hour in aqueous solution. Within a day the body temperature normalized, sore throat completely stopped on the third day. A week later on 12/19/2023 the analysis showed an increase in platelet level up to 257×109/l.
It was decided to discontinue the drug as the platelet level had normalized. However, during January 2024, the platelet count began to decrease again from 257 to 148 and then to 138×109/l. Cracked lips reappeared and the patient’s need to pick them until they bled returned (Figure 8).
It was recommended to increase the potency of Arum triphyllum to 200 CH and take the drug once under the tongue. 4 days after taking the remedy on 01/18/24, platelet count decreased to 102×109/L, lip condition remained the same. Arum triphyllum 200 CH was repeated again, once.
Analysis of 01/29/24 again recorded a drop in platelet level to 78×109/l. Due to the lack of therapeutic effect of 200 CH, it was recommended to switch to the previous scheme Arum triphyllum 30 CH, 3 times a day. After that platelet count started to gradually increase from 78 to 89, then to 112, and finally to 138×109/l. By mid-March on 3/14/24, the platelet count was 124*109/l. The child became ill again with acute respiratory viral infections, at this time in the form of laryngitis.
Fig. 8: Lips condition on 01/18/24
Patient complained of pain in the throat when swallowing and when coughing. The temperature rose to 38.3C- 38.5C. He tolerated it well. It was recommended to take Arum triphyllum 30CN – every hour during the day. Repertorisation was not carried out.
Throat symptom – Pain – with cough was analyzed, where Arum triphyllum was also present, and was in the second degree among 34 remedies. This fact confirmed that the patient was still indicated for the same drug and it was not appropriate to change it. After 3 days, all symptoms of acute respiratory infection were resolved. 04/08/24 – platelet level was 235*109/l. The condition of lips is satisfactory (Fig.9), but continues to pick them. Reception of Arum triphyllum 30CH – once a day continued.
Fig. 9 Lips condition as of 04/08/24
Case analysis, discussion
The child was apparently born in the first health group (A), because despite intrauterine hypoxia and low Apgar scores at birth, he was free of any illness until 15 months of age, receiving all routine vaccinations. Then, most likely due to overloading of the immune system with a large number of vaccinations, the level of health was reduced to 4-5, and the boy began to get acute illnesses with high fever (pneumonia, roseola, chicken pox, sore throats, etc.).
From the age of 3 to 7 years he was sick very often (health level 6) and was repeatedly given antibiotics. At the age of 7 years his body reactivity sharply decreased, the ability to produce acute inflammation was lost (health group C, level 7).
As a result, the ground for a chronic pathology, thrombocytopenia, appeared to develop gradually over 2.5 years and manifested one month after a severe acute respiratory infection (in May 2023) with a fever of 40C, during which the child received treatment that suppressed fever and other symptoms.
This episode was most likely an attempt by an organism that is at the turn of 6/7 levels of health, and therefore still episodically capable of self-regulation and self-healing by developing febrile fever, to prevent a progressive but still latent severe internal disease in the form of autoimmune thrombocytopenia.
Large doses of Nurofen and IRS-19, could only contribute to the manifestation of the disease, since their known side effect is thrombocytopenia. However, the mechanism of development of such drug-induced thrombocytopenia is quite different and does not involve autoimmune reactions.
The clear symptom pattern of Arum triphyllum, which was shown to this patient in the course of treatment not only as a primary treatment for his chronic pathology, but also in acute cases the symptoms clearly pointed to this, albeit relatively rarely used drug.
This fact is not typical for the 7-8 health levels of group C (III), where usually the symptom picture is blurred and the physician has great doubts about the choice of remedy. However, we often observe such a clear picture of the drug in cases when severe pathology has manifested recently, and the patient was initially at a high level of health, but fell into group C on the background of overwhelming treatment, improper lifestyle, stress, etc.
Against the background of ongoing treatment with Arum triphyllum, the patient felt well, bleeding and hemorrhages were not noted, and the platelet level increased, despite the discontinuation of corticosteroid therapy, which had no effect.
It should also be noted that against the background of treatment, the child had two episodes of acute respiratory viral infections with an increase in body temperature to febrile, which undoubtedly indicates the return of the body’s ability to produce acute inflammation, and is a clear confirmation of the correctness of treatment, and accordingly, gives grounds for a favorable prognosis in terms of possible full recovery of the patient.
This fact also testifies to the transition (at this first stage of treatment) of the child’s organism from group C to group B (level 6 of health). With further correct homeopathic treatment, at the next stage of treatment, we should expect the development of a series of various acute infections (tonsillitis, influenza, etc.), which will be accompanied by much higher figures of fever (above 39C).
At the third stage of treatment, in the case of achieving a stable remission of the underlying pathology, the frequency of acute respiratory infections will not differ from the average statistical norm, due to the restoration of normal reactivity and resistance of the body.
The prognosis, in general, is favorable.
Conclusion
This clinical case demonstrates the possibility of using classical homeopathy in the treatment of autoimmune thrombocytopenia. Despite complete ineffectiveness of pulse therapy with methylprednisolone, we managed to achieve not only clinical stabilization in the form of elimination of hemorrhagic syndrome, but also normalization of peripheral blood platelet level.
The choice of the right homeopathic remedy in this case was made on the basis of the totality of symptoms, taking into account a single but important key symptom obtained through observation of the patient. Since the main and unique symptom of this case (“scrapes his lips to the wounds”), which allowed the physician to choose the right homeopathic remedy for the patient (MM Arum trif. V. Bericke, D. Vithoulkas, E.B. Nesch), was not the subject of the complaints and could only be obtained by observing the child.
This once again confirms the relevance of the statements of Samuel Hahnemann, the founder of homeopathy, that one should look for in the patient, first of all, “the most striking … unusual and specific signs and symptoms” (paragraph 153 of S. Hahnemann’s Organon of Medicine. Hahnemann), as well as the extreme importance for the doctor to be able to observe the patient’s behavior, mood, facial expression, gestures, voice, eyes, to conduct a thorough examination, scrupulously recording everything noted (paragraph 90, “Organon of the Medical Art” by S. Hahnemann). The information obtained as a result of such observation is always objective, and accordingly, often gives the key to the correct prescription.
We would also like to note that this case clearly demonstrates aspects of the theory of health levels proposed by George Vithoulkas (“Health Levels” by D. Vithoulkas). Thanks to this theory, we can predict the course of the underlying disease, the patient’s body reactions during treatment, as well as evaluate the effectiveness of the therapy.
