ABSTRACT
Background: In the current pandemic of COVID-19, hydroxychloroquine (HCQ) is recom-mended as an experimental drug for prophylaxis and treatment of the illness. Although it is a safe drug, it can rarely produce a severe drug reaction 'drug rash with eosinophilia and systemic symptoms syndrome (DRESS)', and to differentiate it from systemic viral infections is challenging. Case Presentation: A 45-year old male nurse working in a COVID-19 ward consumed HCQ weekly for two weeks for prevention of SARS-COV-2 illness. He presented with fever, pruritic maculopapular palmar rash, cervical lymphadenopathy for 12 hours and was quarantined as a suspected COVID-19 case. His laboratory tests revealed lymphopenia, eosinophilia, atypical lymphocytes, raised liver en-zymes along with IgM negative, IgG positive rapid antibody test of SARS-COV-2. However, his throat swabs for SARS-COV-2 by real-time PCR were negative on day 1 and 7. He was finally diagnosed as definite DRESS based on the RegiSCAR score of six. He responded to levocetirizine 5 mg OD and oral prednisolone 60 mg daily tapered over 7 days. Conclusion(s): DRESS due to HCQ is 'probable', 'of moderate severity', and 'not preventable' adverse effect mimicking SARS-COV-2 illness.Copyright © 2021 Bentham Science Publishers.
ABSTRACT
Thrombotic thrombocytopenic purpura (TTP) is a rare but fatal thrombotic microangiopathy. Circulating AntiADAMTS13 antibodies produced in response to various triggering events, such as vaccinations, autoimmune disorders, malignancy, and administration of several drugs lead to acquired TTP (aTTP). This case concerns a 26-year-old male with aTTP after receiving the second dose of the Covishield vaccine (Oxford-AstraZeneca COVID-19 vaccine, code-named AZD1222). He presented with bruises, petechia, fatigue, dyspnea, and arthralgia post-vaccination. Laboratory reports showed thrombocytopenia, hemolytic anemia, a significant ADAMTS13 deficiency, and a high level of autoantibody titer against ADAMTS13. We treated the patient with plasma exchange therapy and prednisolone, and after the treatment, he recovered.