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Treatment of Severe Immune Thrombocytopenic Purpura Associated with COVID-19.
Ahmed, Nayab; Asreb, Abdullah; Chofor, Rosemary; Melese, Achenef.
  • Ahmed N; Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, GA, USA.
  • Asreb A; Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, GA, USA.
  • Chofor R; Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, GA, USA.
  • Melese A; Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, GA, USA.
Am J Case Rep ; 22: e932557, 2021 Oct 21.
Article in English | MEDLINE | ID: covidwho-1478477
ABSTRACT
BACKGROUND COVID-19 is associated with many hematological manifestations, including lymphopenia and thrombosis. There have been rare occasions in which thrombocytopenia has been reported as the sole clinical presentation of COVID-19. CASE REPORT This is the case report of a 48-year-old Hispanic female patient with COVID-19 presenting as severe isolated thrombocytopenia. The patient presented to the Emergency Department with hemoptysis, spontaneous bruising, and excessive vaginal bleeding and also reported a recent flu-like illness. On examination, she was found to have bilateral subconjunctival hemorrhage, diffuse oral ulcers, epigastric abdominal tenderness, and ecchymosis on her chest, with scattered petechiae and palpable purpura on her lower limbs. Laboratory results were significant for a platelet count of 0×109 and an immature platelet fraction of 34.1%. Owing to clinical suspicion, the patient was tested for COVID-19, and her test result was positive. She was treated with intravenous immunoglobulin, prednisone, rituximab, vitamin C, and zinc. Upon achieving hemodynamic stability, she was discharged to follow up with a hematologist in the outpatient setting. CONCLUSIONS Hematological consequences of COVID-19 are becoming more prevalent. The mechanism behind this manifestation could be bone marrow failure, formation of platelet autoantibodies, or consumptive coagulopathy. These critical manifestations are necessary to manage, especially in severe forms like in our patient. Steroids and rituximab combination therapy have proven to be the most effective regimen.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Purpura, Thrombocytopenic, Idiopathic / COVID-19 Type of study: Case report / Cohort study / Diagnostic study / Prognostic study Topics: Long Covid Limits: Female / Humans / Middle aged Language: English Journal: Am J Case Rep Year: 2021 Document Type: Article Affiliation country: Ajcr.932557

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombocytopenia / Purpura, Thrombocytopenic, Idiopathic / COVID-19 Type of study: Case report / Cohort study / Diagnostic study / Prognostic study Topics: Long Covid Limits: Female / Humans / Middle aged Language: English Journal: Am J Case Rep Year: 2021 Document Type: Article Affiliation country: Ajcr.932557