eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2023-08-04 11 7 123 125 10.12691/ajmcr-11-7-3 AJMCR20231173 article Anahat Kaur MD 1 Bhanujit Dwivedi MBBS bhanujit.dwivedi@gmail.com 2 Tejasvi Dwivedi MBBS 3 Rubina Sharma MD 4 Angad Singh MD 5 Department of Hematology and Oncology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA Maulana Azad Medical College, New Delhi, India All India Institute of Medical Sciences, Raipur, India PGIMER, Chandigarh, India HCA Midwest Healthcare, Kansas City, KS, USA Evans syndrome is a rare autoimmune disorder characterized by the simultaneous or sequential presence of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Secondary Evans syndrome refers to cases in which these autoimmune manifestations occur in the setting of an underlying condition or trigger. We report the case of a 36 year old male with no significant past medical history who presented with symptoms of easy bruising, and mucocutaneous bleeding. Laboratory investigations revealed severe thrombocytopenia and hemolytic anemia, consistent with the diagnosis of Evans syndrome. Further evaluation demonstrated the presence of triple positive anti-phospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2 glycoprotein antibodies. Patient was initially treated with steroids and IVIG but had refractory ITP for several weeks requiring rituximab (four weekly doses) and fostamatinib before eventual improvement and stabilization of platelet count. Given the rarity of secondary Evans syndrome with positive anti-phospholipid antibodies, there is a lack of robust evidence-based treatment guidelines. Our case highlights the complexity and challenges encountered in managing this condition. http://pubs.sciepub.com/ajmcr/11/7/3/ajmcr-11-7-3.pdf Secondary Evans Anti-phospholipid antibodies Refractory ITP