Proton-pump inhibitors (PPIs) are commonly prescribed for managing gastrointestinal conditions such as peptic ulcers, gastroesophageal reflux disease (GERD) and Zollinger–Ellison syndrome. While they are generally considered safe, long-term PPI use has been associated with adverse effects, including osteoporosis, pneumonia and nutrient deficiencies. A rare but significant adverse effect is drug-induced thrombocytopenia (DITP), which can have severe clinical implications. A 34-year-old female presented with worsening epigastric pain, nausea, vomiting and haematochezia. She had a prior history of gastrointestinal disturbances and was being treated with intravenous pantoprazole, followed by oral esomeprazole. Within 20 days, she developed severe gastrointestinal hemorrhage, a petechial rash and emesis. Laboratory findings revealed severe thrombocytopenia (platelet count: 62,000/μL), suggesting a potential immune-mediated drug reaction to esomeprazole. Immediate discontinuation of the suspected drug and supportive management, including hydration, corticosteroids and platelet monitoring, led to clinical improvement, with platelet recovery observed within four days. This case highlights the critical need for ongoing surveillance for uncommon side effects, such as thrombocytopenia, in patients taking proton-pump inhibitors (PPIs). Healthcare providers, including pharmacists, should be particularly attentive to any signs of blood-related issues, especially in individuals with a history of PPI use. Prompt recognition and management of these potential complications can significantly enhance patient safety. Given the widespread use of PPIs, it is vital to comprehend their risk factors to ensure effective treatment of gastrointestinal conditions while minimizing adverse outcomes.
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