Severe Postoperative Epistaxis Revealing Immune Thrombocytopenia: A Case Report

Postoperative epistaxis is the most common complication after endoscopic sinus surgery (ESS) and septoplasty; however, it is usually immediate and self-limited. Delayed, severe hemorrhage is rare and should prompt evaluation for systemic causes. We report a rare case of acute immune thrombocytopenia (ITP) presenting as delayed, severe epistaxis after routine nasal surgery. A 46-year-old man with no history of bleeding disorders and normal coagulation profiles and platelet counts underwent ESS and revision septoplasty. On postoperative day 5, he presented with massive epistaxis and hypovolemic shock. Laboratory evaluation demonstrated severe isolated thrombocytopenia, with a platelet count of 5×103/μL. He was treated successfully with intravenous immunoglobulin and high-dose corticosteroids, which resulted in platelet recovery and cessation of bleeding. Although uncommon, surgical stress may act as a precipitating trigger for ITP, and this diagnosis should be included in the differential diagnosis of delayed, massive postoperative hemorrhage after routine nasal surgery.