Introduction
Thrombocytopenia is defined as platelet count lower than 150 K/mm3 and is commonly encountered in hospitalized patients1. Drug induced immune thrombocytopenia (DITP) is marked by severely reduced platelet count, often less than 20 K/mm3 range where it could be associated with life-threatening bleeding. The underlying mechanism is understood to be immune mediated platelet destruction caused by drug-induced antibodies2. In 1985, US Food and Drug Administration approved amiodarone for prophylaxis and treatment of potentially fatal ventricular arrhythmias3,4. In practice it is widely used for the management of supraventricular tachyarrhythmias especially atrial fibrillation/atrial flutter, prevention, cardiac arrest from refractory ventricular arrhythmias, treatment of postoperative tachyarrhythmias and as an adjunct to implantable defibrillator4. Physicians are familiar with side effects of amiodarone including hypothyroidism, interstitial pneumonitis, and hepatotoxicity3. An idiosyncratic reaction such as amiodarone-induced immune thrombocytopenia (AITP) is a rare hematologic complication and has been described only a few times5-8. Bone marrow granulomas resulting from long term amiodarone use is a non immune-mediated cause of thrombocytopenia that is usually accompanied by other cytopenias9,10.