Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
Medicine F - Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
Acta Haematol. 2021;144(6):678-682. doi: 10.1159/000514283. Epub 2021 Apr 23.
SARS-CoV-2 has been reported as a possible triggering factor for the development of several autoimmune diseases and inflammatory dysregulation. Here, we present a case report of a woman with a history of systemic lupus erythematosus and antiphospholipid syndrome, presenting with concurrent COVID-19 infection and immune thrombotic thrombocytopenic purpura (TTP). The patient was treated with plasma exchange, steroids, and caplacizumab with initial good response to therapy. The course of both TTP and COVID-19 disease was mild. However, after ADAMTS-13 activity was normalized, the patient experienced an early unexpected TTP relapse manifested by intravascular hemolysis with stable platelet counts requiring further treatment. Only 3 cases of COVID-19 associated TTP were reported in the literature thus far. We summarize the literature and suggest that COVID-19 could act as a trigger for TTP, with good outcomes if recognized and treated early.
据报道，SARS-CoV-2 可能是多种自身免疫性疾病和炎症失调发展的一个触发因素。在这里，我们报告了一例系统性红斑狼疮和抗磷脂综合征病史的女性，同时患有 COVID-19 感染和免疫性血栓性血小板减少性紫癜（TTP）。该患者接受了血浆置换、类固醇和 caplacizumab 治疗，初始治疗反应良好。TTP 和 COVID-19 疾病的过程均较轻。然而，在 ADAMTS-13 活性恢复正常后，患者出现了早发性、意料之外的 TTP 复发，表现为血管内溶血，血小板计数稳定，需要进一步治疗。迄今为止，文献中仅报道了 3 例 COVID-19 相关 TTP。我们总结了文献并提出，COVID-19 可能会引发 TTP，如果及早发现和治疗，结局良好。
