Although extra-pulmonary manifestations of Mycoplasma pneumoniae are well described, immune thrombocytopenia associated with M. pneumoniae is rarely reported. We describe a woman who developed immune thrombocytopenic purpura during an acute mycoplasma infection. The clinical features and outcomes of all previously reported cases are reviewed, and possible mechanisms underlying this association are discussed. Immune thrombocytopenic purpura should be considered early in patients with thrombocytopenia and mycoplasma infections, with the institution of usual therapy for immune thrombocytopenic purpura.