• Sanam Dhakal, Sulochana Neupane, Ankit Mandal, Surya Bahadur Parajuli, and Sulav Sapkota.
• Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal.
• JNMA J Nepal Med Assoc. 2022 May 5; 60 (249): 482-484.

AbstractEvans syndrome is defined as the concomitant or sequential association of warm autoimmune hemolytic anaemia with immune thrombocytopenia, and less frequently autoimmune neutropenia. It is associated with non-cross-reacting auto-antibodies directed against antigens specific to red blood cells, platelets or neutrophils. Clinical symptoms could be related to hemolysis and thrombocytopenia. Evans syndrome is a rare diagnosis of exclusion. The first-line treatment of Evans syndrome is intravenous corticosteroids or intravenous immunoglobulins and second-line treatment with rituximab or splenectomy for those who are refractory to steroids. Here is a case of a fifty-year-old- female who presented with bleeding from the mouth and gums, bluish patches over the shin and trunk along with generalised weakness and severe backache. We are interested in reporting this case because the presentation of patients with such scenarios on our part will compel the treating physician to overlook Evans syndrome and get it underdiagnosed.

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