Severe Bicytopenia and Neutropenic Fever in a Patient With COVID-19 Pneumonia: A Diagnostic Challenge

Coronavirus disease 2019 (COVID-19) is a multisystemic viral infection that primarily affects the respiratory system but is widely recognized for its diverse extrapulmonary manifestations. Hematologic abnormalities, especially those associated with inflammation and disrupted hemostasis, are prevalent and have been extensively reported. However, few cases of profound neutropenia and severe thrombocytopenia have been documented in the literature, making their occurrence extremely rare. Herein, we present a rare case of a 60-year-old woman who presented with a two-week history of painful oral ulcers, fever, chills, sore throat, dyspnea, dry cough, palpitations, and anorexia. She was diagnosed with COVID-19 pneumonia and complicated by acute hypoxic respiratory failure, severe thrombocytopenia, and neutropenic fever. She was treated with supplemental oxygen, dexamethasone, broad-spectrum antibiotics, and granulocyte colony-stimulating factor (G-CSF), resulting in clinical and hematologic recovery.