Altowyan Essam, Alnujeidi Omar, Alhujilan Atheer, Alkathlan Mohammed
Hematolgy Unit, Department of Medicine, King Fahad Specialist Hospital, Qassim, Saudi Arabia
Hematolgy Unit, Department of Medicine, King Fahad Specialist Hospital, Qassim, Saudi Arabia.
BMJ Case Rep. 2020 Dec 17;13(12):e238026. doi: 10.1136/bcr-2020-238026.
We present the case of a 39-year-old man with epigastric pain, nausea and vomiting. The patient scored 4 in the Visual Triage Checklist of acute respiratory symptoms; a COVID-19 swab was taken. Prompt review of the peripheral blood smear showed evidence of microangiopathic haemolytic anaemia and thrombocytopenia. Because the patient had a picture of thrombotic thrombocytopenic purpura, plasma exchange and corticosteroids were started immediately. After 3 days, he developed severe ischaemic stroke and his swabs came back positive for COVID-19 by reverse transcription PCR. Therefore, triple therapy was started (lopinavir/ritonavir, ribavirin and interferon beta-1b). White blood cell count reached 50×10/L (normal range, 4.5-11×10/L), mainly neutrophils. All the workup for autoimmune diseases was negative. The patient showed delayed improvement in lactate dehydrogenase, haemoglobin and platelet count until we increased the volume of plasma exchange and subsided the inflammatory response of COVID-19. After that, the patient showed an excellent recovery.
我们报告一例39岁男性患者，有上腹部疼痛、恶心和呕吐症状。该患者在急性呼吸道症状视觉分诊清单上得分为4分；采集了新冠病毒拭子样本。对外周血涂片的快速检查显示有微血管病性溶血性贫血和血小板减少的迹象。由于该患者有血栓性血小板减少性紫癜的表现，立即开始进行血浆置换和使用皮质类固醇。3天后，他发生了严重缺血性中风，其新冠病毒拭子经逆转录聚合酶链反应检测呈阳性。因此，开始三联疗法（洛匹那韦/利托那韦、利巴韦林和干扰素β-1b）。白细胞计数达到50×10⁹/L（正常范围为4.5 - 11×10⁹/L），主要为中性粒细胞。所有自身免疫性疾病的检查结果均为阴性。患者的乳酸脱氢酶、血红蛋白和血小板计数改善延迟，直到我们增加了血浆置换量并减轻了新冠病毒的炎症反应。此后，患者恢复良好。
