Successful treatment of a COVID-19 patient with thrombotic microangiopathy

Şafak, Seda; Aksoy, Elif; Dirim, Ahmet Burak; Demir, Erol; Garayeva, Nurana; Oto, Özgür Akın; Artan, Ayşe Serra; Yazıcı, Halil; Beşışık, Sevgi Kalayoğlu; Türkmen, Aydın

doi:10.1093/ckj/sfab024

Cited by 10 publications

(11 citation statements)

References 5 publications

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“…The clinical manifestation of SARS-CoV-2–associated HUS, which is an extremely rare complication of SARS-CoV-2 infection ( Jhaveri et al, 2020 ; Mat et al, 2021 ; Safak et al, 2021 ; Ville et al, 2021 ; Boudhabhay et al, 2021 ), should not be confounded with the much more common systemic coagulopathy that is frequently observed in patients with COVID-19 ( Zhou et al, 2020 ; Tang et al, 2020 ; Wu et al, 2020 ). The coagulopathy related to COVID-19 may resemble several systemic coagulation disorders seen in other severe infections, such as disseminated intravascular coagulation ( Gando et al, 2016 ; Levi and Thachil, 2020 ) .…”

Section: Discussionmentioning

confidence: 99%

“…The evidence that complement blockade effectively controls microangiopathy and thrombus formation in atypical HUS, together with the demonstration of complement activation during STEC-HUS, has led to the first attempts of eculizumab use in STEC-HUS, although no systematic assessment of its efficacy in this specific form of HUS is yet available ( Walsh and Johnson, 2019 ) . The good outcome of severe STEC-HUS cases treated with eculizumab provided the rationale for its use in COVID-19–associated HUS ( Jhaveri et al, 2020 ; Mat et al, 2021 ; Safak et al, 2021 ; Ville et al, 2021 ; Boudhabhay et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Conceivably, eculizumab should prove to be even more effective in COVID-19 patients with genetically determined abnormalities in the complement system (as in atypical HUS) and those who present with clinical features of thrombotic microangiopathy (TMA) characterized by the triad of thrombocytopenia, microangiopathic hemolytic anemia, and evidence of organ injury. HUS has been exceptionally reported in association with COVID-19 ( Jhaveri et al, 2020 ; Mat et al, 2021 ; Safak et al, 2021 ; Ville et al, 2021 ; Boudhabhay et al, 2021 ). It could be hypothesized that SARS-CoV-2 may act as a trigger of complement activation in genetically predisposed individuals, as occurs in complement-associated HUS and occasional cases of Shiga toxin–producing Escherichia coli– associated HUS (STEC-HUS) ( Alberti et al, 2013 ) .…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Tackling Complement Hyperactivation With Eculizumab in Atypical Hemolytic Uremic Syndrome Triggered by COVID-19

et al. 2022

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Hemolytic uremic syndrome (HUS) is a rare life-threatening disease of unrestrained complement system dysregulation, microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure in genetically predisposed individuals. In this report, we describe two cases of SARS-CoV-2–associated HUS treated with eculizumab, a C5-blocking monoclonal antibody reported to be remarkably effective in the treatment of HUS. Detailed biochemical and genetic complement system analysis is reported, and the prompt clinical response after C5 pharmacological blockade is documented. Our report provides the rationale and supports the use of terminal complement pathway inhibition for the treatment of SARS-CoV-2–associated HUS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report: Tackling Complement Hyperactivation With Eculizumab in Atypical Hemolytic Uremic Syndrome Triggered by COVID-19

et al. 2022

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“…In addition, a case of TMA was described in a patient with COVID-19 and concurrent metastatic cholangiocarcinoma treated with gemcitabine, and both malignancy and gemcitabine could be associated with the occurrence of TMA [ 27 , 28 ]. Last but not least, there is a report of COVID-19-associated TMA in which hypertensive crisis could act as an accompanying cause of TMA [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy

Vrecko¹,

Večerić-Haler²

2022

J Hematol

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Coronavirus disease 2019 (COVID-19) has spread tremendously since its first appearance in December 2019. Infected individuals can experience a wide range of systemic complications, including thrombotic microangiopathy (TMA). Like the other forms of TMA, COVID-19-associated TMA is characterized by thrombocytopenia, hemolytic anemia, and organ failure (such as acute kidney injury). The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in COVID-19-associated TMA is most probably dual: it can act either as a trigger to an underlying condition or as a cause of TMA. As opposed to the majority of other reported cases, it may be that in our case COVID-19 was the only cause of TMA. We present a case of a 32-year-old previously healthy man who was treated for acute kidney injury associated with TMA, which we believe was caused by COVID-19. Thrombotic thrombocytopenic purpura, as well as other possible known causes of typical and atypical hemolytic-uremic syndrome, was excluded. During his hospitalization, three negative nasopharyngeal swabs for SARS-CoV-2 were obtained, but serological tests showed the presence of IgG and IgA antibodies. After initial treatment known to be helpful in other forms of TMA (therapeutic plasma exchange and methylprednisolone), his renal function and platelet count recovered completely. Our case illustrates the importance of quickly recognizing this life-threatening complication of COVID-19 and using treatment that has been shown to be beneficial in other forms of TMA. Future studies of the pathophysiology and subsequent targeted treatment of this novel disease are needed.

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“…Ville et al reported a case of atypical HUS relapse in a 28-year-old woman who was positive for COVID-19. Again, Eculizumab was started based on clinical and laboratory parameters and within 7 days of therapy hematological parameters and kidney function improved [ 13 ]. Another case of a 69-year-old female with severe COVID-19 illness had concern for TMA and underwent kidney biopsy which showed severe acute thrombotic microangiopathy.…”

Section: Discussionmentioning

confidence: 99%

COVID-19-associated atypical hemolytic uremic syndrome and use of Eculizumab therapy

2021

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There is a high incidence of acute kidney injury with COVID-19 infections. The etiologies of acute kidney injury could be ischemic acute tubular necrosis or a complex process of complement activation leading to thrombotic microangiopathy. We present a case of 32-year-old Hispanic male with a history of heart transplant, admitted with COVID-19 and atypical hemolytic uremic syndrome, which was successfully treated with Eculizumab.

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Successful treatment of a COVID-19 patient with thrombotic microangiopathy

Cited by 10 publications

References 5 publications

Case Report: Tackling Complement Hyperactivation With Eculizumab in Atypical Hemolytic Uremic Syndrome Triggered by COVID-19

Case Report: Tackling Complement Hyperactivation With Eculizumab in Atypical Hemolytic Uremic Syndrome Triggered by COVID-19

Coronavirus Disease 2019-Associated Thrombotic Microangiopathy

COVID-19-associated atypical hemolytic uremic syndrome and use of Eculizumab therapy

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