Abstract
In this case report, we present a patient with severe thrombocytopenia induced by adalimumab after 4 weeks of treatment for rheumatoid arthritis. This case adds to present literature regarding antitumor necrosis factor-alpha (TNF-α)-induced thrombocytopenia and explores the use of thrombopoietin receptor agonist medications in refractory drug-induced immune thrombocytopenia (DITP). A 57-year-old female with a history of rheumatoid arthritis presented to the emergency department for progressive petechial rash 4 days after her third dose of adalimumab. It was determined that the patient had immune thrombocytopenia caused by adalimumab and was initially treated with steroids and intravenous immunoglobulin (IVIG). Platelets remained undetectable; hence, romiplostim was initiated, after which platelets trended up to normal levels a week later. Anti-TNF-α agents carry the risk of severe side effects, including thrombocytopenia, which should be monitored closely in the first few months of therapy. The treatment of DITP is challenging, especially when the causative agent has a prolonged half-life.