or stiffness. By examination, there was no lymphadenopathy or organomegaly, but she had several ecchymoses on her forearms, legs, and back, as well as active synovitis with a little tenderness to palpation. CBC results included a normal hemoglobin and white count, but a platelet count yielded 36,000 mm3 with only occasional large platelets on the smear. Results of a repeat ANA were still negative; permission for a bone marrow examination was refused.
The tolmetin was stopped, and the patient was observed. Within a few days, her platelet count had risen to 43,000 mm3, and no new ecchymoses formed. Two weeks after tolmetin treatment was stopped, the platelet count was 207,000 mm3; it has remained normal. She has subsequently started taking salicylates again, and there has been no recurrence of the bruising; periodic platelet counts have remained over 200,000 mm3.
Nonsteroidal antiinflammatory drugs have only rarely been associated with blood dyscrasias (2). On the package insert for tolmetin "a few cases of granulocytopenia" are listed under the adverse reactions section, but there is no mention of thrombocytopenia. The dose of tolmetin that was used for our patient was well within the dosage range recommended by the manufacturer (3), but she developed thrombocytopenia that only responded to discontinuation of tolmetin therapy. Physicians should watch for this potential complication of tolmetin when this drug is given to children.