Abstract Introduction Immune thrombocytopenia (ITP) is an immune-mediated destruction of platelets, typically mediated by immunoglobulin G (IgG) autoantibodies. While Primary ITP is idiopathic, Secondary ITP may result from infections, autoimmune diseases, malignancies, or medications. Oxaliplatin, a platinum-based chemotherapy agent, is a rare cause of drug-induced ITP(DITP). We describe a case of oxaliplatin-associated ITP that led to massive facial hematoma and airway compromise, requiring fiberoptic nasopharyngeal intubation. Case Description A 68-year-old male with metastatic adenocarcinoma of gastrointestinal origin, on FOLFOX chemotherapy (oxaliplatin, fluorouracil, leucovorin), presented to the hospital with oral bleeding and progressive right-sided facial swelling. He had completed a chemotherapy infusion earlier that day and underwent a right lower molar root canal procedure the day prior. On arrival, he was hemodynamically stable, and labs showed hemoglobin of 12.3 g/dL and platelet count of 3,000/µL—an acute drop from 149,000/µL the previous day. CT scan of the neck revealed a large right-sided facial hematoma extending from the infraorbital region to the hyoid bone. Due to the rapidly expanding hematoma and compromised airway anatomy, the patient was intubated via a fiberoptic nasopharyngeal route on the second attempt, as an oropharyngeal view was obliterated due to the hematoma. He was admitted to the Intensive Care Unit. He was treated with intravenous immunoglobulin (IVIG) and high-dose intravenous steroids for three days, along with 11 units of platelets and a single dose of romiplostim. Eventually, his thrombocytopenia improved, reaching 73,000/µL by day seven of admission. His hematoma stabilized, he was successfully extubated, and later discharged. Oxaliplatin was discontinued following this event. Discussion Severe thrombocytopenia with platelet counts under 20,000/µL poses a high risk for spontaneous bleeding and is considered a hematologic emergency, particularly when bleeding occurs in critical anatomical regions. This case illustrates a dramatic and life-threatening manifestation of oxaliplatin-induced ITP, with airway compromise from soft tissue hemorrhage necessitating urgent intervention. DITP is a diagnosis of exclusion that requires a thorough review of recent medications. In this case, the temporal association with oxaliplatin and rapid recovery following cessation strongly suggests causality. While rare, oxaliplatin-induced ITP has been documented in the literature and should be considered when unexplained thrombocytopenia develops during chemotherapy. Management involves stopping the offending agent and initiating immune-directed therapies such as IVIG, corticosteroids, and thrombopoietin receptor agonists in severe cases. Early recognition, intensive monitoring, and multidisciplinary collaboration were pivotal to this patient’s recovery. This abstract is funded by: None
Anamika et al. (Fri,) studied this question.