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Haematology
Refractory immune thrombocytopenic purpura (ITP) secondary to prior COVID-19 infection requiring a splenectomy
  1. Moki Hein1,
  2. Vielka Fernandez2,
  3. Jacqueline C Barrientos3 and
  4. Steven Hochwald4
  1. 1College of Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
  2. 2Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA
  3. 3Haematology and Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
  4. 4Surgical Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
  1. Correspondence to Moki Hein; mhein013{at}med.fiu.edu

Abstract

Immune thrombocytopenic purpura (ITP) is an uncommon condition resulting from the autoimmune destruction of platelets. A man in his mid-30s, who had received three doses of the SARS-CoV-2 vaccine a year prior, was diagnosed with ITP 3 weeks after contracting COVID-19. Mechanisms of SARS-CoV-2 induced thrombocytopenia may include bone marrow depletion, coagulation consumption, mutations resulting in cytokine release or molecular mimicry leading to autoimmunity. Initial treatment involved glucocorticoids, but the disease course progressed into glucocorticoid-resistant ITP. Subsequently, the patient was diagnosed with ITP refractory to intravenous immunoglobulin, thrombopoietin receptor agonist, rituximab, cyclophosphamide, inhibitors of BTK and SYK, and other pharmacological agents. Despite exhaustive medical interventions, bleeding diathesis and platelet counts worsened, so the patient underwent a splenectomy resulting in the resolution of the thrombocytopenia.

  • Haematology (drugs and medicines)
  • Haematology (incl blood transfusion)
  • Infectious diseases
  • SARS-CoV-2

https://doi.org/10.1136/bcr-2024-259754

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MH, VF, JCB, SH. The following authors gave final approval of the manuscript: MH, VF, JCB, SH.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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