Severe Octreotide-Induced Immune Thrombocytopenia With Bone Marrow Findings Suggestive of Acquired Amegakaryocytic Thrombocytopenic Purpura in a Cirrhotic Woman: An Unusual Case Report

Drug-induced immune thrombocytopenia (DIT) is a rare but potentially life-threatening condition that is often underrecognized in clinical practice. Octreotide, a somatostatin analogue used to control GI bleeding, has rarely been associated with DIT. We describe an 80-year-old woman with metabolic cirrhosis and chronic thrombocytopenia who developed profound thrombocytopenia and severe bleeding shortly after initiating octreotide. Bone marrow evaluation revealed marked megakaryocytic hypoplasia, initially suggestive of acquired amegakaryocytic thrombocytopenic purpura (AATP). Antiplatelet antibodies were detected, and the patient responded rapidly to dexamethasone, intravenous immunoglobulin, and eltrombopag. Although the presentation resembled classic DIT, the marrow findings and clinical course suggested overlapping features of AATP and bone marrow aplasia. This case underscores the diagnostic challenges of thrombocytopenia in cirrhosis, the potential suppressive effect of octreotide on megakaryopoiesis, and the importance of early marrow assessment and immunosuppressive therapy in severe cases.