Late Onset of Gold-Induced Thrombocytopenia:  With a Practical Note on the Injections of Dimercaprol

GOLD-INDUCED thrombocytopenia has been recognized since the 1930s, when colloidal gold became widely used for treating rheumatoid arthritis.¹ The appearance of thrombocytopenia several months after gold therapy is well reported,^2-5 but we have recently seen a patient in whom severe purpura developed 18 months after the last gold injection. So far as we know, this is a record for time elapsed before the onset of gold-related thrombocytopenia.

Report of a Case  A 76-year-old man was examined at Scripps Clinic in 1971 for polymyalgia and fever thought to be polymyalgia rheumatica. At another clinic, a diagnosis of seropositive rheumatoid arthritis was made, and the patient was treated between January 1973 and July 1974 with 2,000 mg of gold sodium thiomalate by the usual regimen of decreasing frequency of injections. He had notable clinical improvement during and after this therapy.Eighteen months later (January 1976), he was hospitalized with epistaxis,