Lupus thrombocytopenia: pathogenesis and therapeutic implications

Galanopoulos, Nikolaos; Christoforidou, Anna; Bezirgiannidou, Zoe

doi:10.31138/mjr.28.1.20

Cited by 23 publications

(33 citation statements)

References 71 publications

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“…In a case series of patients admitted to an intensive care unit (ICU) in Wuhan, a platelet count of <100,000/μL was observed in only 5% of patients [29]. Thrombocytopenia <100,000/μL has been reported in 20% to 40% of patients with SLE [30]. In the present series, thrombocytopenia was reported in 6 of 7 patients and was considered severe (<50,000/μL) and refractory to treatment in 5 cases.…”

Section: Discussionmentioning

confidence: 43%

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Gracia‐Ramos¹,

Saavedra-Salinas²

2020

Preprint

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Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic chronic inflammatory disease that can affect various organs, including skin, joints, kidneys, lungs and the nervous system. Infectious agents have long been implicated in the pathogenesis of SLE. The new viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown that, in genetically predisposed patients, could trigger the presentation or exacerbation of autoimmune disease. We herein report a case of a 45-year-old man who presented respiratory symptoms, bilateral pleural effusion, ascites, splenomegaly, severe thrombocytopenia and renal failure with proteinuria and hematuria. SARS-CoV-2 PCR confirmed the COVID-19 diagnosis. We diagnosed the patient with SLE based on the clinical manifestations and positive immunological markers (2019 European League Against Rheumatism/American College of Rheumatology score of 18). Glucocorticoid pulses were administered to the patient with improvement in renal function. However, thrombocytopenia was also refractory to IV immunoglobulin and rituximab, so the patient underwent splenectomy. Through a systematic search of the medical literature, we retrieved 2 cases with SLE new onset and 5 cases with previous SLE diagnosis that shown activity of disease due SARS-CoV-2 infection. We herein present a systemic review of these cases and discuss the clinical manifestations that could help to the diagnosis of this clinical condition.

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Section: Discussionmentioning

confidence: 43%

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Gracia‐Ramos¹,

Saavedra-Salinas²

2020

Preprint

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show abstract

“…In a case series of patients admitted to an intensive care unit (ICU) in Wuhan, a platelet count of < 100,000/μL was observed in only 5% of patients [29]. Thrombocytopenia < 100,000/μL has been reported in 20-40% of patients with SLE [30]. In the present series, thrombocytopenia was reported in 6 of 7 patients and was considered severe (< 50,000/μL) and refractory to treatment in 5 cases.…”

Section: Discussionmentioning

confidence: 99%

Can the SARS-CoV-2 infection trigger systemic lupus erythematosus? A case-based review

Gracia‐Ramos

Saavedra-Salinas

2021

Rheumatol Int

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Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic chronic inflammatory disease that can affect various organs, including skin, joints, kidneys, lungs and the nervous system. Infectious agents have long been implicated in the pathogenesis of SLE. The new viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown that, in genetically predisposed patients could trigger the presentation or exacerbation of the autoimmune disease. We herein report a case of a 45-year-old man who presented respiratory symptoms, bilateral pleural effusion, ascites, splenomegaly, severe thrombocytopenia and renal failure with proteinuria and hematuria. SARS-CoV-2 PCR confirmed the COVID-19 diagnosis. We diagnosed the patient with SLE based on the clinical manifestations and positive immunological markers (2019 European League Against Rheumatism/American College of Rheumatology, score of 18). Glucocorticoid pulses were administered to the patient, which improved renal function. However, thrombocytopenia was also refractory to IV immunoglobulin and rituximab, so the patient underwent splenectomy. Through a systematic search of the medical literature, we retrieved two cases with newly onset SLE and five cases with previous SLE diagnosis that showed activity of the disease due to SARS-CoV-2 infection. We herein present a systemic review of these cases and discuss the clinical manifestations that could help to the diagnosis of this clinical condition.

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“…It may be the initial feature of lupus in 16% of patients, presenting months or maybe 10 years before diagnosis. Many studies have found that thrombocytopenia is associated with higher mortality, although the onset and severity have not been clearly defined [19]. Treatment options are similar to idiopathic thrombocytopenic purpura, i.e.…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia: A Diagnostic Dilemma and Incidental Detection of Systemic Lupus Erythematosus in a Middle-Aged Asian Male

Maitra

Roy

Mukherjee

et al. 2020

Cureus

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Systemic lupus erythematosus is a multisystem disorder much more common in females than males due to the effect of the hormone estrogen. There are also specific differences in clinical presentation in men and women. We present a unique case of a 54-year-old middle-aged Asian male presenting with only generalized weakness without other systemic features and with only incidental finding of thrombocytopenia. Notable laboratory values were positive for antinuclear antibody (ANA) and anti-double-stranded DNA (dsDNA), low complement 3 level with normal complement 4 levels, along with severe thrombocytopenia and mild anemia. The patient was eventually diagnosed with systemic lupus erythematosus based on these parameters. Bone marrow biopsy revealed an increased number of megakaryocytes without hypocellular or hypercellular marrow and no dysplasia of cell lines. He was initiated on oral prednisone, and his symptoms recovered remarkably with normalization of lab values upon discharge. The case's importance lies in the fact that the diagnosis of lupus can be missed in male patients with nonspecific clinical features due to certain differences in presentation from females. This diagnosis should be included in the workup of any thrombocytopenia.

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Lupus thrombocytopenia: pathogenesis and therapeutic implications

Cited by 23 publications

References 71 publications

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Systemic Lupus Erythematosus triggered by SARS-CoV-2 Infection: A Systematic Review Based on a Case Report

Can the SARS-CoV-2 infection trigger systemic lupus erythematosus? A case-based review

Thrombocytopenia: A Diagnostic Dilemma and Incidental Detection of Systemic Lupus Erythematosus in a Middle-Aged Asian Male

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