Diagnostic dilemma in Evans syndrome

摘要

Evans syndrome, a complex uncommon disease, poses a great diagnostic dilemma due to its variable presentation. The present case of 26-year-old Indian female faced similar difficulty as it was not diagnosed initially when it presented with thrombocytopenia and was treated by platelet concentrate transfusion and steroids. However, the patient showed repeated episodes of remissions and exacerbations without any substantial improvement and later at a tertiary care center it was diagnosed as Evans' Syndrome after direct antiglobulin test and relevant investigations to rule out other causes. This case stresses on the importance of direct antiglobulin test in every patient presenting with autoimmune thrombocytopenia to rule out autoimmune hemolytic anemia and thus excluding this syndrome.