Portal vein thrombosis as a complication of Eltrombopag used in the treatment of immune thrombocytopenia in a patient of chronic liver disease

Eltrombopag is a thrombopoietin receptor agonist which is used an off-label treatment for thrombocytopenia in chronic liver disease (CLD). It is US Food and Drug Administration approved in the treatment of immune thrombocytopenia. However, the literature review suggests its use is associated with increased risk of venous thrombosis including portal vein thrombosis (PVT). There have been several case reports of developing PVT during treatment with Eltrombopag in patients with CLD of varying etiology. We report the case of nonalcohol steatohepatitis-associated CLD with concomitant immune thrombocytopenia who developed PVT 15 days after starting eltrombopag for thrombocytopenia. Our case suggests the possible causation of PVT by eltrombopag in patients with CLD and the need for caution and continuous vigilance for detection of such a complication.