# Secondary Evans Syndrome Presenting With Lupus Anticoagulant

## TL;DR

A case of secondary Evans Syndrome in a man showed lupus anticoagulant and clotting issues, highlighting the need for careful diagnosis and treatment.

## Contribution

This case highlights the novel association of lupus anticoagulant with secondary Evans Syndrome and its management.

## Key findings

- The patient showed thrombocytopenia, anemia, and prolonged aPTT with lupus anticoagulant positivity.
- Treatment with anticoagulation improved clinical outcomes in this secondary Evans Syndrome case.
- The case emphasizes the importance of recognizing hypercoagulable states in Evans Syndrome patients.

## Abstract

Evans syndrome (ES), characterized by autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), often poses diagnostic challenges due to its varied etiology and clinical presentation. We present a case of secondary ES in a 41-year-old male with a history of AIHA and ITP, who presented with lower extremity erythema, warmth, and sensation of chest pressure. Initial laboratory investigations revealed thrombocytopenia, mild anemia, and a prolonged activated partial thromboplastin time (aPTT), prompting further evaluation. Subsequent testing revealed positive lupus anticoagulant (LA), anti-cardiolipin antibodies, and anti-beta-2-glycoprotein 1 antibodies, along with lower extremity deep vein thrombosis (DVT) and bilateral pulmonary embolism (PE). Treatment with therapeutic anticoagulation led to clinical improvement, highlighting the importance of recognizing hypercoagulable states in ES patients. This case underscores the significance of comprehensive differential diagnosis and timely intervention in optimizing outcomes for patients with ES.