ABSTRACT
BACKGROUND: Some conventional vaccines have been recognized as a cause of secondary immune thrombocytopenia (ITP). According to recent publications, mRNA vaccines are probably associated with an increased risk of ITP. CASE PRESENTATION: Our patient developed severe ITP one week after the second dose of COVID-19 mRNA vaccine. Medical management was not effective, requiring splenectomy to obtain sustained remission. CONCLUSION: Considering the temporality and immunological hypothesis, we consider the vaccine to be the trigger of this ITP. To our knowledge, our case is, to date, the most severe case of ITP reported following SARS-CoV-2 vaccination and could help for the therapeutic management of similar patients.
ABSTRACT
RATIONALE: Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction. PATIENT CONCERNS: We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DIAGNOSES: Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection. INTERVENTIONS: The patient was treated with empiric antibiotic and hydroxychloroquine. OUTCOMES: Clinical improvement ensued. At follow-up, the patient is well. LESSON: SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.
Subject(s)
Ceftriaxone/administration & dosage , Coronavirus Infections/diagnosis , Hospitalization , Hydroxychloroquine/administration & dosage , Macrophage Activation Syndrome/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , Blood Chemical Analysis , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques/methods , Coronavirus Infections/drug therapy , DNA, Viral/analysis , Diagnosis, Differential , Disease Progression , Drug Therapy, Combination , Electrocardiography/methods , Follow-Up Studies , Humans , Macrophage Activation Syndrome/therapy , Male , Pandemics , Patient Discharge , Pneumonia, Viral/drug therapy , Radiography, Thoracic/methods , Real-Time Polymerase Chain Reaction/methods , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited genetic disorder caused by red cell enzymatic defects and is associated with haemolytic crisis when patients are exposed to oxidative agents (fava beans, drugs, infections). Hydroxychloroquine is suspected to trigger haemolytic crisis in G6PD-deficient patients, and off-label administration of this drug to patients infected with the novel coronavirus (SARS-CoV-2) could cause concern. We report here the first case of severe haemolytic crisis in a patient with G6PD deficiency, initiated by severe COVID-19 infection and hydroxychloroquine use. With worldwide spread of COVID-19, especially in regions with a high prevalence of G6PD deficiency, our case should alert physicians to this possible correlation.