Infection and Drug Resistance (Jun 2022)
Severe Thrombocytopenic Purpura Associated with COVID-19 in a Pediatric Patient
Abstract
Adelina Raluca Marinescu,1– 3 Voichita Elena Lazureanu,1,2 Virgil Filaret Musta,1,2 Narcisa Daniela Nicolescu,1,2 Alexandra Mocanu,1– 3 Talida Georgiana Cut,1– 4 Camelia Oana Muresan,4,5 Cristina Tudoran,6,7 Monica Licker,8,9 Ruxandra Laza1,2 1Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 2Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timisoara, Romania; 3Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 4Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 5Discipline of Forensic Medicine, Bioethics, Deontology and Medical Law, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 6Discipline of Internal Medicine II, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 7Center of Molecular Research in Nephrology and Vascular Disease, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 8Discipline of Microbiology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania; 9Multidisciplinary Research Centre on Antimicrobial Resistance, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, RomaniaCorrespondence: Talida Georgiana Cut, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania, Tel +4 0755690250, Email [email protected]: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause a diverse spectrum of clinical manifestations ranging from mild, flu-like symptoms to severe progressive pneumonia, acute respiratory distress syndrome with or without other extrapulmonary impairment. Hematological changes such as lymphopenia, neutrophilia, and anemia as the disease progresses, are frequently found in COVID-19. Thrombocytopenia may be drug-induced or can occur secondary to sepsis, disseminated intravascular coagulation or bone marrow suppression. Immune thrombocytopenic purpura (ITP) is frequently observed in children aged 2– 5 years and in 60% of cases may proceed an upper respiratory tract infection. The present paper aimed to raise awareness of ITP as a possible pediatric presentation of coronavirus disease.Patients and Methods: We present the case of previously healthy, eight-year-old female patient, who developed an immune thrombocytopenia flare, also known as immune thrombocytopenic purpura (ITP), in the context of COVID-19, with diffuse petechiae and ecchymosis on her body, face and oral mucosa, and a nadir platelet count of 0× 103/μL.Results: Platelet count recovery was observed after seven days of combined treatment with intravenous immunoglobulin (IVIG) and corticosteroids.Conclusion: The growing body of literature regarding the clinical and laboratory manifestations of COVID-19 infection in children, has reported thrombocytopenia in relation to unfavorable disease progression or multisystem inflammatory syndrome (MIS-C). Clinicians must be aware that ITP may appear both in mild and severe COVID-19, at any time during its course, and can be associated with a higher bleeding risk, thus its diagnostic may be critical.Keywords: SARS-CoV-2 infection, immune thrombocytopenia, bleeding risk, intravenous immunoglobulin
