RESUMO
Thrombocytopenia may be the initial presentation of sarcoidosis, which is a systemic granulomatous disorder. Various pathophysiological mechanisms have been identified. Immune thrombocytopenia often has a severe presentation but may respond favourably to immunosuppressive therapy. There are no guidelines for the treatment of thrombocytopenia in sarcoidosis. However, in emergency situations with major bleeding, it seems reasonable to apply the current guidelines recommended for immune thrombocytopenia. The authors report a case of sarcoidosis presenting with severe thrombocytopenia, petechial rash, and nasal and gingival bleeding. LEARNING POINTS: The association of thrombocytopenia with sarcoidosis has been well described and fully documented.Immune thrombocytopenia in sarcoidosis is usually severe and symptomatic at presentation but generally has a favourable course because of modern therapeutic management.Steroids may be administered as first-line treatment for sarcoidosis, but in emergency situations with a severe bleeding risk, it seems reasonable to apply the current guidelines for immune thrombocytopenia, namely methylprednisolone (1 g/day for 2 days) and/or intravenous immunoglobulin (1 g/kg/day for 3 days).