A 25-year-old man with no known past medical history presented with a 3-year history of intermittent petechiae.
He initially noticed petechiae upon awakening more prominent over periorbital region occurring upto once a month with gradual progression to the face, torso, and shoulders during these episodes. He subsequently began experiencing intermittent paresthesias of the right upper extremity followed by headache. The initial workup including hematological, immunological, and rheumatological workup was negative. CT head did not show any acute pathology.
He was then noted to have a seizure - ictal cry with right-sided head version and eye deviation followed by a generalized tonic-clonic activity lasting for a minute. On presentation to hospital, he was noted to have petechiae in the same distribution mentioned above. The petechiae resolved on the same day. Over the next few days, he had two more seizures with similar transient petechiae. He was then diagnosed with recurrent seizures as cause of transient petechiae.
He underwent MRI brain revealing focal cortical dysplasia in the left peri-rolandic region in postcentral gyrus and electroencephalogram which was unremarkable. He was started on levetiracetam and he remains seizure-free and petechiae-free since then.