key: cord-355191-jghvq3cy
authors: Yang, Yang; Zhao, Jun; Wu, Jian; Teng, Yi; Xia, Xinyi
title: A Rare Case of Immune Thrombocytopenic Purpura Secondary to COVID‐19
date: 2020-05-22
journal: J Med Virol
DOI: 10.1002/jmv.26051
sha: 
doc_id: 355191
cord_uid: jghvq3cy

Coronavirus Disease 2019 (COVID‐19) is a newly emerging infectious disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). After its first occurrence in Wuhan of China from December 2019, COVID‐19 rapidly spread around the world. Studies have shown that coagulation dysfunction is one of the important reason causing death of COVID‐19 patients and appeared in many patients. However, cases of COVID‐19 with immune thrombocytopenic purpura were very rare. Here, a patient with immune thrombocytopenic purpura in Huoshenshan Hospital (Wuhan, China) was reported, whose laboratory data, clinical treatment and hospital outcome was described in this study. Fortunately, immune thrombocytopenic purpura with COVID‐19 of the patient was diagnosed and treated in time and cured eventually. This case illustrates the need to be vigilant for complications associated with COVID‐19. This article is protected by copyright. All rights reserved.

A novel coronavirus SARS-CoV-2 emerged to cause a major outbreak of severe pneumonia in humans in China and has spread to over 200 other countries until May 15 th 2020, and 4,338,658 cases with 297,119 deaths (6.8% case fatality rate) had been reported to the World Health Organization (WHO) 1 . Studies have shown that coagulation dysfunction is one of the important reason causing death of COVID-19 patients, and 71% of death patients achieved the diagnostic criteria of the International Society for blood clots bleeding (International Society on Thrombosis and Haemostasis, ISTH) of disseminated intravascular coagulation (disseminated intravascular coagulation, DIC) 2 . There have been many reports of SARS-CoV-2 causing thrombocytopenia, but ITP is rarely seen, and the latest case of COVID-19 with ITP has been reported in a patient with autoimmune hypothyroidis, found in France 3 .

In this study, a patient with immune thrombocytopenic purpura in Huoshenshan Hospital (Wuhan, China) was reported after reviewing electronic records of a total of 3059 patients from February 4 to March 30. This study was approved by the Medical Ethical Committee of Wuhan Huoshenshan Hospital.

Written informed consent was obtained from the patient.

A 32-year-old woman complained of fever, cough and fatigue without any obvious cause at February 3rd 2020, and the body temperature was up to 39.4℃.

After taking the medicine, the body temperature dropped to normal.

7.84*10 9 /L, red blood cell count was 3.78*10 12 /L. The patient's blood image was slightly higher, which was considered to be caused by taking glucocorticoids, and continued to receive methylprednisolone treatment (2 tablets per day).

Blood routine examination of March 10th showed: absolute neutrophil count was 6.41*10 9 /L, and the platelet count was 119*10 9 /L. Chest CT indicated that the lesion had been mostly absorbed, and there was no fever for more than 3 consecutive days. Novel coronavirus antibody IgG was single positive, and 2 pharyngeal swabs (sampling time > 24 hours) tests for novel coronavirus nucleic acid were both negative, which met discharge standards. Blood routine examination of March 12 th showed the platelet count was 113*10 9 /L which reached a stable level, and discharge was processed on March 14 th .

The 32-year-old female in our study was as case1 and the 65-year-old female in France 3 was as case2, comparison of two cases were presented in Table1, and progression of the case1 was showed in Figure1.

In most COVID-19 with thrombocytopenia cases, the platelet count did not decrease to a level at which bleeding occurs. Although the mechanism of thrombocytopenia in COVID-19 is still unclear, researchers indicated the possible mechanisms of thrombocytopenia in COVID-19 patients, similar to SARS 4 , including decreased primary platelet production caused by cytokine storm and 

Coronavirus disease (COVID-19) situation dashboard

We declare no competing interests.