Cocaine-Induced Manic Episode and Severe Thrombocytopenia: A Complex Diagnosis of Exclusion in a Young Adult: A case Report

Background: Cocaine is a potent psychostimulant known to precipitate acute psychiatric manifestations, including manic or psychotic episodes. Hematological complications are rare but increasingly described, particularly thrombocytopenia associated with toxic or immune-mediated mechanisms. Case Presentation: We report the case of a 32-year-old man with no psychiatric history who developed an acute manic episode following massive cocaine use. Laboratory evaluations revealed severe thrombocytopenia (30,000/mm³) without hemorrhagic manifestations. Infectious, immunological, and hematological investigations were unremarkable. Cocaine-induced thrombocytopenia was diagnosed. Clinical improvement was observed under olanzapine, with full normalization of platelet count after cocaine withdrawal. Conclusion: This case illustrates the need for rigorous diagnostic exclusion and interdisciplinary collaboration when managing psychiatric presentations associated with unexpected hematological abnormalities in cocaine users.