Since we do have thrombocytopenia, normal PT and PTT it seems less likely that there actually exists any coagulopathy but definitely Thrombocytopenia. Common would be ITP and in the absence of any previous hemangioma I wouldn't put too much money on Kasaelbach Merrit Syndrome. The unusual site of bleed did cause me to wonder of abuse, ignored in our country, however I still have to explain the low Platelets. Lets do a Bone Marrow and look at the state of the megakaryocytes; Scan the liver just incase we do have liver AV malformations. What is that white string like lesion seen in the photgraph? Is it pus or a drain of sorts?
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