Coexistence of Pancytopenia and Myositis After Developing COVID-19

Okayasu, Tatsuhiko; Ohta, Ryuichi; Igarashi, Mari; Kurita, Yasuo; Hayakawa, Miho; Sano, Chiaki

doi:10.7759/cureus.26978

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Pancytopenia is not a disease but a laboratory term describing the reduction in all three types of blood cells. Several cases of pancytopenia as a manifestation of long-COVID disease have been reported in the medical literature [ 12 , 13 , 14 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Persistent Pancytopenia as a Long-COVID Manifestation in a Patient with Adult-Onset Still’s Disease: A Case Report

et al. 2023

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Background: Adult-onset Still’s disease (AOSD) is a rare rheumatic inflammatory condition with an extremely heterogeneous clinical presentation and systemic impairment. Uncommon manifestations may be challenging to manage, especially in patients with previous severe acute SARS-CoV-2 infection. For the first time, we report the case of a patient affected by refractory AOSD presenting with severe pancytopenia as a long-COVID manifestation. The purpose of this case report is to illustrate the clinical presentation, diagnostic and therapeutic management of this unusual manifestation. Moreover, we examine the mechanisms that are potentially responsible for the onset of the pancytopenia observed in our patient. Case presentation: We describe the case of a 40-year-old male who presented with a history of fever for 2 years, arthralgia, maculopapular salmon-pink rash and a previous SARS-CoV-2 infection which required admission to intensive care. The patient’s laboratory results revealed elevated inflammatory markers levels (erythrocyte sedimentation rate and C-reactive protein), hyperferritinemia and severe pancytopenia that needed multiple transfusions. A diagnosis of AOSD was made based on clinical and laboratory presentation after excluding neoplastic, infectious and other rheumatic diseases. The previous empirical treatment was not adequate to control the condition; therefore, treatment with high-dose steroids, canakinumab and epoetin alfa was started and led to the resolution of the man’s symptoms and a reduction in inflammatory marker levels, whereas blood cell count remained stable without a need for further blood transfusions. The patient is currently under rheumatologic and hematologic follow-up every month. Conclusions: Neither AOSD nor SARS-CoV-2 infection usually manifests with pancytopenia, except in hemophagocytic syndrome or immunodeficient patients, respectively. Identifying the underlying etiology of pancytopenia is mandatory to establish a prompt treatment that generally resolves the disorder. However, in our case, all common causes of pancytopenia were excluded, suggesting a potential manifestation of the long-COVID syndrome. Despite the resolution of the acute infection and the remarkable treatment of AOSD, pancytopenia persists. Herein, we propose for refractory AOSD patients with previous SARS-CoV-2 infection a novel approach to the diagnosis and treatment of pancytopenia.

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Section: Discussionmentioning

confidence: 99%

Persistent Pancytopenia as a Long-COVID Manifestation in a Patient with Adult-Onset Still’s Disease: A Case Report

et al. 2023

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“…Early on the presence of auto-Abs in the blood was regarded as pathognomonic for the AIDs but this too has been refuted by a flood of contradictory [75][76][77][78][79][80][81][82][83][84][85][86], inflammatory myositis [87][88][89][90][91][92][93][94][95], myocarditis [96][97][98][99], vasculitic syndromes like Kawasaki's disease [100][101][102][103][104], type I diabetes [105][106][107][108][109][110], multiple sclerosis [111][112][113][114][115][116][117], autoimmune encephalitis [118][119][120], Guillain-Barré syndrome [121][122][123]…”

Section: The Many Faces Of Inflammationmentioning

confidence: 99%

Energy Dynamics in the Autoimmune Disorders: The Unity of Immunity

Thorp,

Northrup

et al. 2023

G Med Sci

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In this paper we examine the autoimmune disorders (AIDs) not from a cellular/ molecular standpoint as scientists have attempted for decades but from a dynamic energy-based perspective. Not only does this framework account for the origins of these disorders but it explains phenomena that cell-based mechanisms cannot. In addition, we examine the historical basis of 20th century immune theory and point to serious errors in the research literature that have lain unrecognized for over a century and which led to broad misconception of immune functions.

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A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

et al. 2023

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A literature review on new-onset autoimmune connective tissue diseases (ACTDs) following COVID-19 is lacking. We evaluated potential associations between COVID-19 and the development of new-onset ACTDs. The “population” was adults with disease terms for ACTDs, including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), anti-synthetase syndrome, mixed CTD and undifferentiated CTD, and “intervention” as COVID-19 and related terms. Databases were searched for English-language articles published until September 2022. We identified 2236 articles with 28 ultimately included. Of the 28 included patients, 64.3% were female, with a mean age was 51.1 years. The USA reported the most cases (9/28). ACTD diagnoses comprised: 11 (39.3%) IIM (including four dermatomyositis); 7 (25%) SLE; four (14.3%) anti-synthetase syndrome; four (14.3%) SSc; two (7.1%) other ACTD (one lupus/MCTD overlap). Of eight, four (14.3%) patients (including that with lupus/MCTD) had lupus nephritis. The average time from COVID-19 to ACTD diagnosis was 23.7 days. A third of patients were admitted to critical care, one for treatment of haemophagocytic lymphohistiocytosis in SLE (14 sessions of plasmapheresis, rituximab and intravenous corticosteroids) and nine due to COVID-19. 80% of patients went into remission of ACTD following treatment, while three (10%) patients died—one due to macrophage activation syndrome with anti-synthetase syndrome and two from unreported causes. Our results suggest a potential association between COVID-19 and new-onset ACTDs, notably in young females, reflecting more comprehensive CTD epidemiology. The most common diagnosis in our cohort was IIM. The aetiology and mechanisms by which ACTDs emerge following COVID-19 remain unknown and require further research.

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Coexistence of Pancytopenia and Myositis After Developing COVID-19

Cited by 4 publications

References 19 publications

Persistent Pancytopenia as a Long-COVID Manifestation in a Patient with Adult-Onset Still’s Disease: A Case Report

Persistent Pancytopenia as a Long-COVID Manifestation in a Patient with Adult-Onset Still’s Disease: A Case Report

Energy Dynamics in the Autoimmune Disorders: The Unity of Immunity

A systematic review of the incidence, management and prognosis of new-onset autoimmune connective tissue diseases after COVID-19

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