Abnormal immunothrombosis and lupus anticoagulant in a catastrophic COVID-19 recalling Asherson’s syndrome

Abstract

Background Coronavirus disease 2019 (COVID-19) is a complex disease with many clinicopathological aspects, including abnormal immunothrombosis, and the full comprehension of its pathogenetic mechanisms is urgently required. Methods/Results By means of a multidisciplinary approach, we here report a catastrophic COVID-19 in a 44-year-old Philippine male patient, discovered lupus anticoagulant (LAC)-positive shortly before death, occurred 8 days after hospitalization in a clinical scenario refractory to standard high acuity care recalling Asherson's syndrome (catastrophic antiphospholipid syndrome). Conclusion A parallelism between this severe form of COVID-19 and Asherson's syndrome can be so drawn. Both the diseases in fact exhibit hypercytokinemia, thrombotic microangiopathy, disseminated intravascular coagulation and multiple organ failure, they show a relationship with viral infections, and they are burdened by a high mortality rate. A genetic predisposition to develop these two overlapping conditions may be supposed. Keywords Coronavirus disease 2019 (COVID-19) • Abnormal immunothrombosis • Lupus anticoagulant (LAC) • Megakaryocytes • Antiphospholipid syndrome (Hughes syndrome) • Asherson's syndrome Highlights• COVID-19 is the most dramatic pandemic of the new millennium characterized by many clinicopathological facets, among which abnormal immunothrombosis • Abnormal immunothrombosis is a leading cause of COVID-19 related deaths, and its impact can be amplified by the presence of antiphospholipid autoantibodies, such as LAC • In this setting, the simultaneous occurrence of venous and arterial thromboses should alert the clinicians towards a secondary antiphospholipid syndrome, sometimes burdened by a catastrophic evolution in genetically predisposed patients • The catastrophic variant of a secondary antiphospholipid syndrome takes also the name of Asherson's syndrome, from the rheumatologist Ronald Andrew Asherson, who described it in 1992 • The implications of all this for future directions are in favor of a routine antiphospholipid testing in severe COVID-19 patients, and its introduction under intensive care as potential prognostic risk marker

A novel case of lupus nephritis and mixed connective tissue disorder in a COVID-19 patient

“…Out of the total papers, eleven articles were from Asia [ 19 , 22 , 25 , 30 , 32 , 33 , 36 , 39 , 41 , 43 , 44 ], eight from Europe [ 15 , 17 , 18 , 20 , 24 , 27 , 38 , 45 ], eleven from North America [ 14 , 16 , 26 , 28 , 29 , 34 , 35 , 37 , 40 , 42 , 46 ], two from South America [ 21 , 31 ] and one from Africa [ 23 ].…”

Untangling the Intricacies of Infection, Thrombosis, Vaccination, and Antiphospholipid Antibodies for COVID-19

“…Others find that the presence of antiphospholipid antibodies may be a strong predictor of endothelial activation in vitro [73]. It remains tempting to propose that a rapid and severe COVID-19 illness may bear similarity to catastrophic antiphospholipid syndrome when associated antibodies are determined [75].…”

Ultramicronized Palmitoylethanolamide and Luteolin: Drug Candidates in Post-COVID-19 Critical Illness Neuropathy and Positioning-Related Peripheral Nerve Injury of the Upper Extremity

“…9 Unlike Guillain-Barré syndrome, another neurological disorder that leads to muscle weakness, CIP patients do not show demyelination phenomena. 5 Coronavirus disease 2019 (COVID-19) has shocked the globe since the World Health Organization declared its pandemic spread 10 ; nowadays, it is well known that patients with serious COVID-19 can stay in intensive care for weeks in a clinical scenario of "cytokine storm" or SIRS, [11][12][13][14][15] and that surviving patients can develop CIP as a consequence of COVID-19. [16][17][18][19][20][21][22] Prone positioning-related stretch can be added to this, favoring the onset of positioning-related peripheral nerve injuries (PNI).…”