Severe Immune Thrombocytopenia Complicated by Intracerebral Haemorrhage Associated with Coronavirus Infection: A Case Report and Literature Review

Abstract

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder that causes isolated thrombocytopenia. Many viruses have been identified as triggering the autoimmune process, including HIV, MCV, EBV, parvovirus, rubella and measles. However, ITP in association with coronavirus infection has not previously been reported. We describe the case of a healthy man who presented with severe ITP complicated by intracranial haemorrhage following upper respiratory tract infection. An infection screen revealed coronavirus infection.

Novel Coronavirus Disease 2019 and Subarachnoid Hemorrhage: A Case Report

“…A patient in Thailand presented with petechiae only and later tested positive for COVID-19 [10]. A case report prior to this pandemic had linked immune thrombocytopenic purpura (ITP) to coronavirus [11]. However, our patient did not have thrombocytopenia on initial lab tests.…”

Neurological consequences of COVID-19 and brain related pathogenic mechanisms: A new challenge for neuroscience

“…Intracerebral hemorrhage has been also reported ( Agarwal et al, 2020 ), with emphasis in the elderly and in ICU hospitalized COVID-19 patients, being categorized as a rare manifestation with a high risk of mortality ( Abboud et al, 2020 ; Yanan Li et al, 2020 ), and described up to rates of 59% of lethality ( Abbas et al, 2021 ). This symptom in some cases is accompanied by severe immune thrombocytopenia following upper respiratory tract infection ( Magdi and Rahil, 2019 ) or multiple microhemorrhages (e.g. intraparenchymal hemorrhage, subarachnoid hemorrhage and subdural hematoma), and finally sometimes accompanied by cognitive declined ( Magdi and Rahil, 2019 ).…”

“…This symptom in some cases is accompanied by severe immune thrombocytopenia following upper respiratory tract infection ( Magdi and Rahil, 2019 ) or multiple microhemorrhages (e.g. intraparenchymal hemorrhage, subarachnoid hemorrhage and subdural hematoma), and finally sometimes accompanied by cognitive declined ( Magdi and Rahil, 2019 ). It is required to elucidate the causes, the risk and the outcome of the cerebrovascular complications through studies using large sample sizes.…”

Practical Recommendations for the Management of Patients With Itp During the Covid-19 Pandemic

“…However, in such cases - if applicable - the administration of intravenous immunoglobulins (IVIg), 400 mg/day for 5 days or 1 g/kg/day for 1–2 days, is preferred. In case of major life-threatening bleeding or associated with severe organ damage, such as cerebral hemorrhage, 17 the use of platelet transfusion remains recommended. There are no reported cases of SARS-CoV-2 transmission through platelet transfusions.…”