Successful outcome of a patient with evans syndrome underwent treatment for uterine leiomyoma

Evans syndrome (ES) is a rare autoimmune disorder characterized by the combination of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), with or without neutropenia. Patients often experience frequent relapses hence require long-term immunosuppressive therapy and corticosteroids using as first line therapy.Uterine fibroids (leiomyomas/myomas) are the commonest benign uterine tumors, frequently presenting with heavy menstrual bleeding or pelvic pressure symptoms and management depends on various factors such as age, fertility wishes and fibroid characteristics.Coexistence of Evans syndrome with uterine fibroids brings unique management challenges, especially in perioperative care due to hematological instability.We report the case of a 49-year-old nulliparous woman with Evans syndrome (ES), referred for management of menorrhagia secondary to a large uterine leiomyoma. She had a history of multiple ES relapses and was on maintenance therapy with prednisolone, mycophenolate mofetil (MMF), and cyclosporin. On admission, she had severe anemia and moderate thrombocytopenia. Despite initial medical management, her bleeding persisted, necessitating the Total Abdominal Hysterectomy. A multidisciplinary team approach was carried out. Preoperative optimization included multiple blood transfusions and immunosuppressive adjustments. During transfusions, suspected relapses of ES caused worsening of thrombocytopenia, which was successfully managed with intravenous methylprednisolone. Surgery proceeded without complications. Immunosuppressive therapy was reinitiated postoperatively, and the patient was discharged in stable condition.This case reflects the importance of coordinated multidisciplinary care in patients with complex autoimmune disorders undergoing major surgeries. Preoperative optimization, vigilant perioperative monitoring, and tailored management strategies are crucial to achieve favorable outcomes in such scenarios.