Severe immune thrombocy-topenia dosewith advancedof nivolumabinducednon-smallbyina singlea patient cell lung cancer

Nivolumab-induced immune thrombo-cytopenia (ITP) is a rare process with few reported cases. We present a 67-year-old man with advanced non-small cell lung cancer who was hospitalized with severe thrombocytopenia. Physical exam was notable for petechiae across his chest and extremities as well as bullae in his oral cavity. The patient initially received high-dose glucocorticoids and intravenous immuno-globulin, but did not respond to treatment. He was then started on weekly rituximab and after three doses, there wascomplete resolution of his thrombocytopenia. Altogether, his presentation was an extreme case and rare side effect of immune checkpoint therapy, known as nivolumab-induced ITP. Diagnosis of nivolumab-induced ITP is challenging given the lack of specific test-ing and a wide differential diagnosis. There are few cases reporting severe ITP follow-ing nivolumab treatment. We highlight the importance of recognizing and treating this rare complication of immunotherapy.