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Context Pancreatic adenocarcinoma presenting as idiopathic thrombocytopenic purpura has not been previously reported in the literature.Case report A newly diagnosed patient with metastatic pancreatic adenocarcinoma developed thrombocytopenic purpura prior to initiation of chemotherapy. Generalized petechiae were present and peripheral smear revealed giant platelets. Drug induced and other thrombotic platelet consuming disorders were ruled out. Her platelets returned to normal after being treated with steroids.Conclusions ITP can be associated with metastatic pancreatic adenocarcinoma and can respond well to steroid treatment.