Patel, Parth S

ABSTRACT Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by antibody‐mediated platelet destruction, often driven by long‐lived plasma cells (LLPCs) resistant to conventional therapies. While most patients respond to corticosteroids and intravenous immunoglobulin (IVIG), a subset develops life‐threatening refractory disease. In this case series, we describe three patients aged 39, 85, and 58 with life‐threatening, multi‐agent refractory ITP and platelet nadirs < 2 × 10 9 /L who failed corticosteroids, IVIG, and thrombopoietin receptor agonists (TPO‐RAs). Following salvage therapy with daratumumab, a monoclonal antibody targeting CD38, all three patients achieved rapid hematologic recovery, with platelet count normalization within 1 week. This accelerated response allowed for urgent clinical stabilization, including safe anticoagulation and surgical intervention. The efficacy of daratumumab likely stems from a dual mechanism: the depletion of CD38+ LLPCs and the immediate modulation of Fc‐receptor‐mediated platelet clearance. These observations suggest that CD38‐targeted therapy can bypass traditional treatment resistance to achieve near‐immediate remission in high‐complexity, high‐risk clinical settings. While these results are compelling, prospective clinical trials are warranted to define the long‐term safety, durability, and optimal dosing of anti‐CD38 therapies in refractory ITP populations.

Ischemic monomelic neuropathy (IMN) is a rare peripheral neuropathy caused by limb ischemia and subsequent nerve degeneration, typically manifesting with unilateral pain, paresthesia, and numbness without overt signs of limb ischemia. This case report describes a 59-year-old female with extensive peripheral artery disease who developed IMN in her right lower extremity following an acute, intraoperative in-sheath thrombosis during a right femoral endarterectomy and external iliac artery stent placement, a rare etiology distinct from the more commonly reported associations with bypass surgery or hemodialysis access. Despite successful intraoperative revascularization, the patient developed diminished motor and sensory function with unremitting pain, and subsequent electromyography confirmed a length-dependent neuropathy with features of denervation, consistent with IMN. This case underscores the critical need for clinicians to consider IMN in the differential diagnosis of post-procedural neuropathic pain, even in the absence of classic ischemic signs and following seemingly successful vascular interventions, as acute thrombotic events during vascular procedures can precipitate this debilitating condition.