A 35-year-old postpartum woman presented with gastrointestinal symptoms, anemia, thrombocytopenia, and acute kidney injury (AKI) and later suffered from splenic rupture. After extensive evaluation, she was diagnosed with Evans syndrome (ES). ES is characterized by the co-occurrence of multiple autoimmune cytopenias (AIC), most commonly autoimmune hemolytic anemias (AIHA) and immune thrombocytopenia (ITP). Since the incidence is exceedingly rare, the management is considerably difficult due to a lack of structured guidelines, leading to considerable patient morbidity. Our patient's treatment regimen included combinations of steroids, IV immunoglobulin, mycophenolate, and eculizumab. Here, we highlight the diagnostic complexity and therapeutic challenges associated with ES, particularly when triggered by pregnancy or infection.
