LAUSR

Evans syndrome is a rare autoimmune condition marked by the coexistence of autoimmune hemolytic anemia and immune thrombocytopenia, often triggered by infections or immune dysregulation. We present the case of a 22-year-old male who arrived in critical condition with shock, high-grade fever, jaundice, and melena. He tested positive for dengue (NS1 antigen) and chikungunya co-infection. Laboratory workup revealed pancytopenia, microcytic hypochromic anemia, deranged liver and renal function, and imaging showed splenomegaly, ascites, and bilateral pleural effusions. Although initial stabilization was achieved, persistent severe thrombocytopenia raised concern. A positive direct Coombs test and ANA, along with bone marrow biopsy findings of reticulocytopenia, early precursor maturation arrest, increased megakaryocytes, and hemophagocytosis confirmed Evans syndrome. Severe neutropenia, an unusual complication of Evans syndrome, led to profound immunosuppression, and he subsequently tested positive for leptospira, presenting in its severe form, Weil’s disease. This resulted in worsening renal failure, elevated pancreatic enzymes, cardiac involvement, and eventual multiorgan dysfunction. NA This case highlights the need to recognize the chain of events in complex presentations where overlapping tropical infections, immune dysregulation, and complications interact dynamically. Timely pathological investigations, including bone marrow biopsy and autoimmune workup, are essential to guide early intervention in such multifactorial, high-risk scenarios.