Evans Syndrome with Brachial Plexopathy and Steroid-Induced Gastritis

Evans syndrome is a rare, autoimmune disorder characterized by autoimmune hemolytic anemia and immune thrombocytopenia. Brachial plexopathy occurs due to damage of brachial plexus which results in weakness, numbness, and pain in the arm and shoulder. Here is a case of a 52-year-old male, who presented with complaints of bleeding gums and melena for the past 3 days, left arm and shoulder pain for the past 4 days, and generalized weakness and rashes over lower limbs for the past 1 week. Relevant blood investigations revealed anemia and thrombocytopenia. Peripheral blood smear reported severe normocytic normochromic anemia with relative neutrophilia and severe thrombocytopenia. Local examination showed purpura over bilateral lower limbs. The nerve conduction studies were suggestive of brachial plexopathy. In suspicion of steroid-induced gastritis, proton pump inhibitor infusion and antacids were started. Evans syndrome results in chronic immune system dysregulation. We find it important to report this case as sharing such scenarios can help healthcare professionals consider Evans syndrome along with brachial plexopathy as a potential diagnosis.