Severe refractory thrombocytopenia in a woman positive for coronavirus disease 2019 with lupus and antiphospholipid syndrome

Hayden, Alina; Vyas-Lahar, Aishwarya; Rudinskaya, Alla

doi:10.1177/0961203320940389

Cited by 20 publications

(27 citation statements)

References 8 publications

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“…Of the 8 patients (including ours), 6 (75%) were women with a median age of 48 years (range 18-85 years) ( Table 2). Five cases (63%) occurred in patients with previous history of SLE (one case with associated antiphospholipid syndrome and another case with end-stage renal disease secondary to WHO Class IV lupus nephritis) [11,12,14,16,17]. The nonspeci c clinical manifestations reported were fever in 5 cases [12,13,16,17 and present report], malaise in 3 cases [13,17 and present report], 1 case with headache [14] and 1 case with myalgia and arthralgia [present report]).…”

Section: Resultsmentioning

confidence: 67%

“…Five cases (63%) occurred in patients with previous history of SLE (one case with associated antiphospholipid syndrome and another case with end-stage renal disease secondary to WHO Class IV lupus nephritis) [11,12,14,16,17]. The nonspeci c clinical manifestations reported were fever in 5 cases [12,13,16,17 and present report], malaise in 3 cases [13,17 and present report], 1 case with headache [14] and 1 case with myalgia and arthralgia [present report]). Organ-speci c manifestations reported were pulmonary (cough in 4 cases [13,14,17 and present report], shortness of breath in 4 cases [12][13][14], chest discomfort in 1 case [11] and peripheral cyanosis in 1 case [15]), cardiovascular (2 cases with circulatory collapse [13,15]), hematological (hemoptysis in 1 case [16], gingival bleeding in 1 case [11] and 1 case with diffuse purpuric rash [14] [11,13,14], positive anticardiolipin antibodies in 2 cases [13,14], and positive anti-β2-glycoprotein 1 antibodies in 2 cases [13,14].…”

Section: Resultsmentioning

confidence: 67%

“…After removing the duplicate citations, title and abstracts of 48 articles were reviewed, and 9 articles relevant to the topic of the review were reviewed to detail. Seven case reports were found to be relevant to this research ( Figure 2) [11][12][13][14][15][16][17]. With the present report, a total of 8 cases were included for this review.…”

Section: Resultsmentioning

confidence: 99%

“…Reported SLE activity was hematologic in 6 patients [11,13- [13,17]. The diagnosis of SARS-CoV-2 infection was made by PCR test in 7 patients [11][12][13][14]16,17] and by serologic test in 1 patient [15]. Imaging studies found bilateral pleural effusion in 3 cases [13,15 and present case], patchy ground-glass opacities in 5 cases (one with chronic interstitial lung brosis) [12][13][14]16,17], bilateral reticular pattern with vascular enlargement in 1 case [present case], pericardial effusion with tamponade in 1 case [13] and impaired left ventricle ejection fraction in 1 case [13].…”

Section: Resultsmentioning

confidence: 99%

“…The diagnosis of SARS-CoV-2 infection was made by PCR test in 7 patients [11][12][13][14]16,17] and by serologic test in 1 patient [15]. Imaging studies found bilateral pleural effusion in 3 cases [13,15 and present case], patchy ground-glass opacities in 5 cases (one with chronic interstitial lung brosis) [12][13][14]16,17], bilateral reticular pattern with vascular enlargement in 1 case [present case], pericardial effusion with tamponade in 1 case [13] and impaired left ventricle ejection fraction in 1 case [13]. The treatment used in patients with a previous diagnosis of SLE included hydroxychloroquine-belimumab-azathioprine-warfarin [16]; hydroxychloroquinemycophenolic acid [12,17]; prednisone [11]; and no therapy [14].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

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: Resultsmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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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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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Immune globulin/prednisone

2020

Reactions Weekly

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Immune globulin/prednisone Lack of efficacy: case report A 51-year-old woman experienced lack of efficacy following treatment with prednisone and immune globulin for thrombocytopenia. The woman was diagnosed with systemic lupus erythematosus at the age of 33 years. Shortly thereafter, she developed acute deep-vein thrombosis which was diagnosed with antiphospholipid syndrome. Eight years later (i.e. at the age of 41 years), she developed acute occlusion of the right posterior tibial artery, resulting in a left below-knee amputation complicated by a perioperative cerebrovascular accident. Over the following 10 years, her disease was successfully managed with hydroxychloroquine, azathioprine, belimumab and warfarin. She had chronic mild thrombocytopenia. At the age of 51 years, she presented with haemoptysis in the setting of COVID-19 infection. Her blood tests revealed isolated thrombocytopenia. A peripheral blood smear showed thrombocytopenia without evidence of platelet clumping. Red blood cells and white blood cells counts were normal in both numbers and morphology. A CT scan of the chest demonstrated ground glass opacities in the left lower lobe. Immune thrombocytopenic purpura was suspected, and she received one unit of platelets on admission; however, no effect on her platelet count was noted. Azathioprine, belimumab and warfarin were held, and hydroxychloroquine (off-label therapy to treat COVID-19) was continued at 300mg daily. On hospital day 1, she started receiving IV immune-globulin and received two doses over days 1 and 2 (total of 2 g/kg body weight), with no effect on the platelet count. On day 2, oral prednisone 60mg daily was initiated. On day 3, she received another unit of platelets, but her platelet count remained unchanged. However, she had felt well since admission, did not have haemoptysis and did not require supplemental oxygen. On day 7, she received IV immune-globulin at 1 g/kg body weight, with no improvement in the platelet count. In view of the severe thrombocytopenia refractory to prednisone and immune-globulin, the woman received treatment with eltrombopag on hospital day 8. The following morning, her platelet count improved. Her platelet count further improved after 4 days of eltrombopag therapy. She was discharged on prednisone 60mg daily and eltrombopag.

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Severe refractory thrombocytopenia in a woman positive for coronavirus disease 2019 with lupus and antiphospholipid syndrome

Cited by 20 publications

References 8 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

Immune globulin/prednisone

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