COVID-19 induced immune thrombocytopenic purpura: case report

Immune thrombocytopenic purpura (ITP) is an autoimmune state of decreased platelets caused by antibody or T-cell mediated destruction of platelets through the reticuloendothelial system and impairment of their production. Symptoms of ITP include bleeding usually from nose or gums, easy bruising, petechiae commonly of lower extremities, menorrhagia, hematuria, hematemesis, hematochezia and most dreadful, intra cranial hemorrhage. Molecular mimicry between viral antigens and host platelet antigens forming cross-reactive anti-platelet autoantibodies may lead to increased platelet clearance in ITP associated with viral infections. One of the many viruses associated with this is the Coronavirus disease 2019 (COVID-19). It has caused a devastating pandemic. It can activate innate and adaptive immune responses. It has numerous signs and symptoms including but not limited to dyspnea, fever, cough, fatigue, myalgias, loss of taste and smell. It leads to diseases such as pneumonia, acute respiratory distress syndrome, thrombosis and cardiomyopathy. Hematologic manifestations include thrombocytopenia and more commonly lymphopenia. Treatment includes steroids, immune globulin, romiplostim, eltrombopag, rituximab or splenectomy. Contact sports should be avoided due to risk of intra cranial bleeding with head impact. Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin should be used with caution since they impair platelet function. We discuss a patient with COVID-19 who developed thrombocytopenia thought to be due to ITP. Not much is known about the association between the two. It is important to keep this differential in mind when taking care of patients with COVID-19 who develop thrombocytopenia.