Immune Thrombocytopenia Triggered by Sildenafil-Containing Rhino 69 Platinum 1000: A Case Report

Drug-induced immune thrombocytopenia (DITP) is a rare but serious complication resulting from exposure to certain medications, herbal products, and dietary supplements. Although various agents have been implicated, sildenafil-containing over-the-counter supplements have not previously been associated with this phenomenon. Herein, we report a case of a 24-year-old male who presented with diffuse purpuric rash, gum bleeding, and epistaxis over three days. Laboratory testing revealed severe isolated thrombocytopenia (platelet count of 4,000/µL). Extensive workup for infectious, hepatic, autoimmune, and thrombotic etiologies was unremarkable. Upon further history, the patient disclosed use of "Rhino 69 Platinum 1000," an unregulated sexual enhancement supplement containing undeclared sildenafil over the prior two weeks. He received intravenous immunoglobulin (IVIG) and high-dose dexamethasone with a rapid platelet recovery. After discontinuing the supplement, his platelet counts normalized, and he remained symptom-free during one year of follow-up. No other cause of thrombocytopenia was identified. This report highlights a probable case of DITP associated with the use of "Rhino 69 Platinum 1000." To our knowledge, this is a rare reported case implicating this supplement or sildenafil as a potential trigger for DITP.