In March 2024, a 22-year-old man suffering from chronic Diarrhea reached out through his uncle, a close friend of mine. Due to his remote location, we conducted a Teleconsultation. After a 22-minute assessment, there were no red flags, and I diagnosed him with Irritable Bowel Syndrome (IBS), recommending dietary changes and medication.

When his symptoms persisted 2 weeks later, I suggested Probiotics. Another week passed with no improvement, so I recommended further investigations. But he was unable to get a colonoscopy due to limited resources. In June 2024, I advised him to come to Hyderabad for proper care.

Here, a Gastroenterologist diagnosed him with *Ulcerative Colitis* and prescribed a tapering dose of Corticosteroids and Mesalazine. He felt relieved with the confirmed diagnosis.

However, by July 2024, he expressed doubts and sought a second opinion. The diagnosis was confirmed, but another drug was added.

Weeks later, he sent me alarming photos showing Severe Hair Loss (Anagen Effluvium) and extreme fatigue. To my shock, he had been prescribed a second immunosuppressant – Azathioprine, alongside Mesalazine—an unsafe combination due to the risk of bone marrow suppression.

I urged him to contact his gastroenterologist.

But the doctor advised continuing the drugs.

By September 2024, his mother took him to a Hematologist in Delhi, who ordered a Bone Marrow Biopsy. While Malignancy was ruled out, the Biopsy revealed PANCYTOPENIA – caused by *drug-induced bone marrow suppression.*

This case highlights the dangers of fragmented care, where Specialists failed to communicate or take responsibility for the Patient’s overall well-being. Ultimately, the Patient and his family suffered from conflicting advice and unmonitored drug interactions.