Acquired pure red cell aplasia after severe acute respiratory syndrome corona virus 2 infection: a case report

Abstract

Background Coronavirus disease 2019, caused by severe acute respiratory coronavirus 2, has been responsible, since December 2019, for a severe pandemic resulting in millions of deaths worldwide, and the number is still increasing. Although coronavirus disease 2019 is mostly a respiratory syndrome, it is considered a multisystemic disease and shows clinical diversity with a wide range of manifestations including hematological features. Case presentation We present the case of an Arab male, 77 years old, who developed severe anemia 8 weeks after acute infection with severe acute respiratory coronavirus 2. The investigations revealed acquired pure red cell aplasia. Workup for an associated underlying disorder was negative, ruling out secondary causes. The patient received corticosteroids as the standard treatment of primary acquired pure red cell aplasia, and he had a good response to treatment. Conclusion This case illustrates that acquired pure red cell aplasia might occur weeks after severe acute respiratory coronavirus 2 infection, suggesting that it might be considered a delayed complication of coronavirus disease 2019. The most relevant hypothesis of the pathogenesis of acquired pure red cell aplasia, in this case, is an immune mechanism triggered by infection with severe acute respiratory coronavirus 2 resulting in interruption of normal erythroid differentiation. We highlight the importance of follow-up care after the acute phase of coronavirus disease 2019 to spot late complications in order to successfully manage the secondary burden of the pandemic.

Exacerbation of autoimmune hemolytic anemia associated with pure red cell aplasia after COVID-19: A case report

“…In our case, AIHA and PRCA were induced after a low-grade symptom of COVID-19 associated with mild fever, suggesting that slight or asymptomatic COVID-19 infection could cause such hematological disturbances. Although previous reports on COVID-19-associated PRCA that were resistant to PSL treatment and recovery after the administration of cyclosporine [ 15 ] or tacrolimus [ 13 ] were published, our case and the case by Karrat et al [ 12 ] showed a good response to PSL as shown in Table 2 . The case by Ghimire et al [ 14 ] also showed a response to dexamethasone.…”

“…Our case was associated with simultaneous occurrence of AIHA and PRCA after COVID-19. As per our search, simultaneous occurrence of AIHA and PRCA [ 14 , 15 ], or occurrence of PRCA [ 12 , 13 ] after COVID-19 have rarely been reported. Those reported patients including our case are summarized in Table 2 .…”

“…Currently, reports of AIHA occurrence after COVID-19 are being accumulated [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. However, reports of PRCA [ 12 , 13 ] or the simultaneous occurrence of AIHA and PRCA [ 14 , 15 ] have rarely been reported. Moreover, the manifestation of COVID-19 in our case was low-grade and only associated with mild fever.…”