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Complicated case of COVID-19 disease with overlapping features of thrombotic thrombocytopenic purpura and haemophagocytic lymphohistiocytosis
  1. Durga Prasad Verma1,
  2. Himanshu Dandu2,
  3. Geeta Yadav3 and
  4. Shailendra Prasad Verma1
  1. 1Clinical Hematology, King George's Medical University, Lucknow, Uttar Pradesh, India
  2. 2Medicine, King Georges Medical University, Lucknow, Uttar Pradesh, India
  3. 3Pathology, King Georges Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Shailendra Prasad Verma; spverma1998{at}


Haemophagocytic lymphohistiocytosis has been reported as an uncommon complication of severe COVID-19 disease while thrombotic thrombocytopenic purpura has been rarely reported. Here, we are reporting a 21-year-old man who developed a combination of these complications during the hospital stay in the post-COVID-19 recovery period. He presented with fever and bilateral COVID-19-related pneumonia requiring invasive ventilation. His hospital course was complicated by the development of pneumothorax, ventilator-associated pneumonia, thrombotic thrombocytopenic purpura and haemophagocytic lymphohistiocytosis. He received remdesivir, IVIG, steroid, fresh frozen plasma and supportive care but had a fatal outcome.

  • COVID-19
  • haematology (incl blood transfusion)
  • pneumonia (infectious disease)
  • mechanical ventilation

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  • Contributors DPV and SPV have written the case and discussion. GY has provided laboratory support and bone marrow evaluations. HD has helped in preparation of the manuscript and discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.