Nguyen Hien, Nguyen Michelle, Olenik Angela
Department of Internal Medicine, Kaiser Permanente, Temple Hills, USA.
Department of Pharmacy, Kaiser Permanente, Temple Hills, USA.
Cureus. 2023 May 22;15(5):e39342. doi: 10.7759/cureus.39342. eCollection 2023 May.
Immune thrombocytopenic purpura (ITP) has been described following both coronavirus disease 2019 (COVID-19) infection and COVID-19 vaccination. ITP is a challenging diagnosis of exclusion, and the pathophysiology of these complications is not well understood but believed to be autoimmune in nature. We describe a severe case of ITP following COVID-19 infection in a patient without a history of hematologic or autoimmune disease and his subsequent uneventful course following COVID-19 vaccination. The current Centers for Disease Control and Prevention (CDC) advisory does not identify a history of ITP as a contraindication to COVID-19 vaccination. We compare our study, which describes an uneventful COVID-19 vaccination course with cases that have described recurrences and relapses of ITP following both COVID-19 infection and COVID-19 vaccination. These reports suggest that the placement of some patients into a unique subset among all patients with ITP may be prudent with regard to future COVID-19 vaccination. Through a literature review, we discuss a broader picture of how COVID-19 infection-associated ITP may differ from COVID-19 mRNA vaccination-associated ITP in its demographics, etiology, and outcomes.
免疫性血小板减少性紫癜（ITP）在2019冠状病毒病（COVID-19）感染和COVID-19疫苗接种后均有报道。ITP是一种具有挑战性的排除性诊断，这些并发症的病理生理学尚未完全了解，但被认为本质上是自身免疫性的。我们描述了一例在没有血液学或自身免疫性疾病病史的患者中，COVID-19感染后发生的严重ITP病例，以及他随后在COVID-19疫苗接种后的平稳病程。美国疾病控制与预防中心（CDC）目前的咨询意见并未将ITP病史确定为COVID-19疫苗接种的禁忌证。我们将我们描述了COVID-19疫苗接种平稳病程的研究与那些描述了COVID-19感染和COVID-19疫苗接种后ITP复发和再发情况的病例进行了比较。这些报告表明，对于未来的COVID-19疫苗接种，将一些患者归入所有ITP患者中的一个独特亚组可能是谨慎的做法。通过文献综述，我们讨论了COVID-19感染相关ITP在人口统计学、病因和结局方面可能如何不同于COVID-19 mRNA疫苗接种相关ITP的更广泛情况。
