A Sudden Onset of Severe Thrombocytopenia While Using Evolocumab

Abstract EN

A 72-year-old man with a 10-year history of coronary heart disease started evolocumab treatment once a month after developing excess myalgia due to therapy with a 3-hydroxy-methylglutaryl CoA reductase inhibitor.

No side effects such as myalgia symptoms had been reported during the first 14 months of evolocumab treatment; however, he suddenly presented with acute severe thrombocytopenia following the 14th treatment.

His platelet count continued to decrease to a nadir of 1,000/μL.

His platelet-associated immunoglobulin G level had elevated to 790 ng/107 cells.

He started receiving a combination of steroid therapy, high-dose immunoglobulin therapy, and platelet transfusions, but the first-line therapy was ineffective.

He was subsequently treated with a thrombopoietin receptor agonist, and his platelet count recovered to 250,000/μL.