Evans syndrome associated with antiphospholipid antibodies in a patient with SARS-COV-2 infection

Zarza, José; Horoch, Jorge Von; Aguayo, Nicolás; Báez, E

doi:10.1016/j.htct.2020.08.003

Cited by 7 publications

(5 citation statements)

References 9 publications

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“… 30 aCL or a-β2-GPI IgG or IgM 5/56 LAC 25/56 N.A. [ 43 ] 1 M 31 1 LAC Acute limb ischemia, myocardial infarction [ 159 ] 1 F 30 1 aCL IgG and IgM, a-β2-GPI IgG and IgM, LAC No thrombotic events, Evans syndrome [ 160 ] Abbreviations. aPL: antiphospholipid antibody.…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…Few cases of COVID-19 have been reported to occur in the setting of Evans syndrome, complicating the interpretation of CVST in this patient. 18,19 Our patient had been diagnosed with Evans syndrome approximately 8 years prior, with no interval thromboembolic events despite additional therapeutic predisposing factors, including avatrombopag. Therefore, we think it is possible that COVID-19 decreased the threshold for the development of CVST in this patient in the setting of her underlying predisposition.…”

Section: Discussionmentioning

confidence: 96%

“…Early reports suggest that neurologic complications are frequent in patients with coronavirus disease 19 (COVID- 19), occurring in 36% to 65% of hospitalized patients. 1,2 While early reports described stroke as a complication seen primarily in critically ill patients, up to 5% in a cohort from Wuhan, 1 other studies have described many cases of stroke in COVID-19 patients from the community.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature

Nwajei

Anand

Abdalkader

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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Introduction : Early studies suggest that acute cerebrovascular events may be common in patients with coronavirus disease 2019 (COVID-19) and may be associated with a high mortality rate. Most cerebrovascular events described have been ischemic strokes, but both intracerebral hemorrhage and rarely cerebral venous sinus thrombosis (CVST) have also been reported. The diagnosis of CVST can be elusive, with wide-ranging and nonspecific presenting symptoms that can include headache or altered sensorium alone. Objective : To describe the presentation, barriers to diagnosis, treatment, and outcome of CVST in patients with COVID-19. Methods : We abstracted data on all patients diagnosed with CVST and COVID-19 from March 1 to August 9, 2020 at Boston Medical Center. Subsequently, we reviewed the literature and extracted all published cases of CVST in patients with COVID-19 from January 1, 2020 through August 9, 2020 and included all studies with case descriptions. Results : We describe the clinical features and management of CVST in 3 women with COVID-19 who developed CVST days to months after initial COVID-19 symptoms. Two patients presented with encephalopathy and without focal neurologic deficits, while one presented with visual symptoms. All patients were treated with intravenous hydration and anticoagulation. None suffered hemorrhagic complications, and all were discharged home. We identified 12 other patients with CVST in the setting of COVID-19 via literature search. There was a female predominance (54.5%), most patients presented with altered sensorium (54.5%), and there was a high mortality rate (36.4%). Conclusions : During this pandemic, clinicians should maintain a high index of suspicion for CVST in patients with a recent history of COVID-19 presenting with non-specific neurological symptoms such as headache to provide expedient management and prevent complications. The limited data suggests that CVST in COVID-19 is more prevalent in females and may be associated with high mortality.

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“…In the case of Zarza et al (Case 5), there were anti-nuclear (ANA) and antiphospholipid antibody (APA) positivities. The patient was likely to have lupus-like syndrome, and steroids and hydroxychloroquine were beneficial during treatment [ 11 ]. In the case report of Georgy et al (Case 6), IVIG was not feasible, only dexamethasone could be used, and the patient died of intracranial hemorrhage [ 12 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…In addition, COVID-19-related thrombosis risk, caused by thromboinflammation, endothelial activation, and anti-phospholipid antibodies, is amplified by ongoing hemolysis and increased fractions of young platelets in ES [ 5 , 7 ]. Here, we aim to present a patient as well as the cases of five other patients who developed ES due to COVID-19, as documented in the literature [ [8] , [9] , [10] , [11] , [12] ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19-associated Evans syndrome: A case report and review of the literature

Turgutkaya

Bolaman

Yavaşoğlu

2022

Transfusion and Apheresis Science

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Evans syndrome is a rare condition characterized by simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia (and/or immune neutropenia). Coronavirus disease 2019 (COVID-19) may cause various hematologic conditions, such as coagulation abnormalities (e.g., bleeding or thrombosis) or cell count alterations (e.g., lymphopenia and neutrophilia). COVID-19 may also induce Evans syndrome via immune mechanisms. Here, we describe the case of a patient developing Evans syndrome shortly after COVID-19 infection. Immune thrombocytopenia and warm-type autoimmune hemolytic anemia developed simultaneously, and intravenous immunoglobulin and methylprednisolone were initially administered. Additionally, we intend to review all COVID-19-induced Evans syndrome cases currently present in the literature and emphasize the differences as well as the similarities regarding patient characteristics, relationship to COVID-19 infection, and treatment approach. Since autoimmune cytopenias are frequent in COVID-19 patients, clinicians should pay particular attention to profound and abrupt-onset cytopenias. In these circumstances, hemolysis markers such as lactate dehydrogenase, haptoglobulin, Coombs tests, etc. should be investigated, and the possibility of Evans syndrome should always be considered to ensure prompt and appropriate treatment. These factors are essential to ensure hematologic recovery and prevent complications such as thrombosis.

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Evans syndrome associated with antiphospholipid antibodies in a patient with SARS-COV-2 infection

Cited by 7 publications

References 9 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

Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature

COVID-19-associated Evans syndrome: A case report and review of the literature

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