Steroid Toxicity in Immune Thrombocytopenia – A Series of Unfortunate Events: A Case Report

Immune thrombocytopenia (ITP) is a common bleeding disorder characterised by isolated thrombocytopenia, due to immune-mediated accelerated platelet destruction, usually without any specific or identifiable precipitating factor. ITP most commonly presents with bleeding associated with a low platelet count <100×109/L. Corticosteroids are the first line of treatment in adults. However, steroid-induced complications are widespread in patients with ITP, and sometimes are more atrocious than the risk of bleeding associated with thrombocytopenia. The authors report the case of a 29-year-old male with ITP with recurrent episodes of epistaxis, who was treated with prednisolone for 8 weeks and developed acne, steroid-induced hyperglycaemia, and urinary tract infection with epididymitis and pyocele. A few weeks later, the patient developed blurring of vision, and was found to have central serous chorioretinopathy. They were treated adequately for each of these complications, and had complete resolution of symptoms following cessation of steroids. While acne and hyperglycaemia are common, urinary tract infections with epididymitis and central serous chorioretinopathy are infrequent complications following steroid administration. The complexity of adverse events and the challenges in diagnosing and treating these unique complications prompted the authors to report this case.