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Background: Evans syndrome is characterized by simultaneous or sequential development of autoimmune thrombocytopenia (AITP) and autoimmune hemolytic anemia (AIHA). Case characteristics: We report a case of a boy who presented with persistent thrombocytopenia and bleeding manifestations. Intervention: Although he was treated successfully mystery still shrouds the evolution and final diagnosis of this rare and enigmatic disease. Message: We have reported this case to highlight the need for awareness of this rare entity. This requires a high index of suspicion among primary care physicians.