Background: Thrombocytopenia is a common finding in individuals infected with HIV and its incidence increases with progressive immunosuppression. Thrombocytopenia due to AIDS is divided into primary and secondary forms and primary HIV associated thrombocytopenia (PHAT) is the most common cause of thrombocytopenia in these patients.

Case presentation: The patient was a 35-year old man with HIV since 1996, who was admitted to Imam Khomeini hospital in August of 2010 with petechiae, purpura, ecchymosis around the eyes and on the limbs and subconjunctival hemorrhage. In laboratory investigation, platelet count was 5000/µL. After ruling out the secondary causes of thrombocytopenia, Primary HIV Associated Thrombocytopenia (PHAT) was diagnosed. Due to the presence of severe thrombocytopenia and bleeding symptoms and considering the fact that antiretroviral agents require 4- 6 weeks to reach therapeutic effects, prednisone and antiretrovirals (AZT) were prescribed. After about two weeks of steroids administration, platelet count reached 50,000/µL and about eight weeks after antiretroviral (AZT) therapy platelets reached nearly 140,000/µL.

Conclusion: Prednisone can be used safely in conjunction with antiretrovirals for primary thrombocytopenia in HIV infected patients with severe thrombocytopenia and bleeding symptoms.