Gold induced thrombocytopenic purpura

Thrombocytopenic purpura is a rare but often fatal complication of the treatment of rheumatoid arthritis with gold. The two cases described, and a review of the literature, provide evidence of different mechanisms, possibly immunologically mediated, as the cause of this disorder and emphasize the difficulties encountered in assessing response to therapy. Despite this complexity and the fact that not all patients exhibit a successfull response, experience to date suggests that immediate therapy with dimercaprol (BAL) and steroids is indicated in this order.