Evans syndrome in a child

A Bedouin girl, aged 2 3/12, was first seen at the age of 9 months for sequential onset of Coombs-positive hemolytic anemia and immune thrombocytopenia. Comprehensive laboratory workup revealed no underlying disease. Evans' syndrome, relatively rare in childhood, was diagnosed and corticosteroid therapy initiated. She responded well and normal hemoglobin and thrombocyte counts were achieved within a month. All attempts at tapering-off the dose of corticosteroids resulted in relapses, until high-dose intravenous gamma-globulin was given.