Treatment of severe immune thrombocytopenic purpura associated with covid-19

Abstract

Patient: Female, 48-year-old Final Diagnosis: COVID 19 infection • severe idiopathic thrombocytopenic purpura Symptoms: Bruising • headcahe • hemoptysis • nausea Medication: — Clinical Procedure: — Specialty: Hematology • Infectious Diseases Objective: Background: Case Report: Conclusions: Rare coexistence of disease or pathology 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. 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 bruis-ing, 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 ecchy-mosis 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 suspi-cion, 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. Hematological consequences of COVID-19 are becoming more prevalent. The mechanism behind this mani-festation 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.