Immune Thrombocytopenic Purpura in Patients with COVID-19
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Thrombocytopenia has been associated with severe COVID-19 disease. This report describes three patients with peripheral thrombocytopenia considered to have an autoimmune aetiology as common causes were excluded. The patients were successfully treated with intravenous immunoglobulins.

Case 1: A 57-year-old woman was admitted with petechiae on her legs and gingival mucosae. She had a medical history of psoriatic arthritis treated with methotrexate, folic acid and adalimumab. Two SARS-CoV-2 nasopharyngeal swabs taken 1 week apart were negative on RT-PCR testing. However, computed tomography (CT) of the chest showed ground-glass opacities in the lower zones, strongly suggestive of COVID-19 infection.

Case 2: A 76-year-old man was admitted for fever and slight purpura on his legs. He had a history of metastatic bronchiolar adenocarcinoma with a PDL-1 expression level of 100%, treated with carboplatin, pemetrexed and pembrolizumab with a good response. A nasopharyngeal swab was positive for COVID-19 on RT-PCR testing. The most severe thrombocytopenia occurred 11 days after the first symptoms of SARS-CoV-2 infection.

Case 3: A 39-year-old man was admitted for fever, arthralgias, cough, body aches and unilateral epistaxis 7 days after exposure to his two sons who had RT-PCR-confirmed COVID-19. He had a medical history of immune thrombocytopenic purpura (ITP) in 2005, treated with Disulone, which had been stopped several years before admission. A nasopharyngeal swab was positive for SARS-CoV-2 on RT-PCR testing.

Conclusively, An immune aetiology should be considered when other mechanisms have been ruled out in profound and acute thrombocytopenia. SARS-CoV-2 provokes an immune reaction which has a good response to intravenous immunoglobulins in mild or moderate COVID-19.