Immune thrombocytopenia flare with mild COVID‐19 infection in pregnancy: A case report

Nesr, George; Garnett, Catherine; Bailey, Chris; Koshy, Rincy; Arami, Siamak

doi:10.1111/bjh.16928

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…Another case concerned a 37-year-old woman who was treated with mycophenolate mofetil for ITP secondary to systemic lupus erythematosus and had a flare during mild COVID-19 [ 29 ]. ITP exacerbation also occurred in a 34-year-old woman during the second trimester of pregnancy [ 30 ] and a de novo disease was diagnosed in another pregnant woman [ 31 ]. Among patients affected by ITP, death was determined to be secondary to intracerebral bleeding [ 32 ], or respiratory deterioration [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patients affected by autoimmune diseases are reasoned to be generally more susceptible to infections, due to the use of the immunosuppressive treatments and particularly when the disease status is not fully under control [ 91 ]. In some cases, in fact, these patients can develop disease flares or new autoimmune complications in the context of SARS-CoV-2 infection, as described for patients with pre-existing hemolytic anemia [ 12 ], ITP [ 29 , 30 ], and arthritis [ 71 ]. It is to be noted that diverse outcomes of SARS-CoV-2 infection in patients with existing autoimmune disease appear in the literature.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

Novelli

Motta

Santis

et al. 2021

Journal of Autoimmunity

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

Novelli

Motta

Santis

et al. 2021

Journal of Autoimmunity

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“…After the search, 32 articles with a total of 56 cases were selected. 1–32 Our own patient was also included in the final analysis, so 57 cases were analyzed.…”

Section: Methodsmentioning

confidence: 99%

Immune thrombocytopenia and COVID-19: Case report and review of literature

Alonso-Beato

Morales‐Ortega

Fernández

et al. 2021

Lupus

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Immune thrombocytopenia, also known as immune thrombocytopenic purpura (ITP), has been reported as an important complication related to COVID-19. We present a 49-year-old male patient with systemic lupus erythematosus with lupus nephritis, antiphospholipid syndrome and history of ITP who developed an ITP flare in the context of COVID-19. He had no bleeding manifestations and had a good response to prednisone treatment. We review the characteristics of the cases reported to date in the literature, with an analysis of 57 patients. Mean age was 56 years (±19.6 SD), and 50.9% were male. This was the first episode of ITP in most of the patients (86.05%), with SARS-CoV-2 acting as the initial trigger. We found that ITP flares may appear in both mild and severe COVID-19 cases. They also appeared at any time during the course of the disease, 48.2% of patients developed it during hospitalization, while it was diagnosed at admission in the rest of the cases. Platelet counts were significantly lower than other ITP series, with a median nadir platelet count of 8 × 109/L (IQR 2–17.75 × 109/L). These patients show a higher bleeding rate (61.4%) compared with other ITP series. They also show a better response to treatment, with good response to the first line therapies in 76.9% of them. The most common first-line treatment was intravenous immunoglobulin (IVIG), used alone or combined with corticosteroids in 40.4% and 32.7% of cases respectively, while 25% of patients received only corticosteroids. Our review suggests that COVID-19-related ITP can be seen even in previously healthy patients. Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course. Given that this kind of ITP seems to be associated with a higher bleeding risk, its diagnosis in a clinical scenario such as COVID-19, where anticoagulant therapy is frequently used, may be critical. Treatment with IVIG and/or corticoids is often effective.

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“…The authors speculated that it was partly immune-mediated (95). Table 4 demonstrated 38 cases of immune thrombocytopenic purpura (ITP) associated with COVID-19 infection, and some of them only had mild or asymptomatic COVID-19 (90,(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112)(113). Most of these patients with thrombocytopenia were diagnosed by exclusion and had a favorable response to corticosteroids, IVIG, and even thrombopoietin receptor agonists.…”

Section: Hematological Manifestationsmentioning

confidence: 99%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

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Immune thrombocytopenia flare with mild COVID‐19 infection in pregnancy: A case report

Abstract: Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. Thrombosis UK

Cited by 12 publications

References 12 publications

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

Immune thrombocytopenia and COVID-19: Case report and review of literature

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

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