Infection and Drug Resistance (May 2022)

Clinical Implication of the Effect of the Production of Neutralizing Antibodies Against SARS-Cov-2 for Chronic Immune Thrombocytopenia Flare-Up Associated with COVID-19 Infection: A Case Report and the Review of Literature

  • Maekura C,
  • Muramatsu A,
  • Nagata H,
  • Okamoto H,
  • Onishi A,
  • Kato D,
  • Isa R,
  • Fujino T,
  • Tsukamoto T,
  • Mizutani S,
  • Shimura Y,
  • Kobayashi T,
  • Okumura K,
  • Inaba T,
  • Nukui Y,
  • Kuroda J

Journal volume & issue
Vol. Volume 15
pp. 2723 – 2728

Abstract

Read online

Chika Maekura,1 Ayako Muramatsu,1 Hiroaki Nagata,1 Haruya Okamoto,1 Akio Onishi,1 Daishi Kato,1 Reiko Isa,1 Takahiro Fujino,1 Taku Tsukamoto,1 Shinsuke Mizutani,1 Yuji Shimura,1,2 Tsutomu Kobayashi,1 Keita Okumura,3 Tohru Inaba,4 Yoko Nukui,4 Junya Kuroda1 1Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Blood Transfusion, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; 3Faculty of Clinical Laboratory, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; 4Department of Infection Control & Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, JapanCorrespondence: Junya Kuroda, Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan, Tel +81 75 251 5740, Fax +81 75 251 5743, Email [email protected]: Previous studies have demonstrated that the appropriate production of serum anti-severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) neutralizing antibody (nAb) plays a critical role in the recovery from coronavirus disease 2019 (COVID-19); however, the role of nAb production in the recovery from a flare-up of chronic immune thrombocytopenia (ITP) has been unknown. We here report the first retrospectively investigated case of serum anti-SARS-Cov-2 nAb production during chronic ITP flare-up triggered by COVID-19. A 79-year-old woman with a history of corticosteroid-refractory ITP visited our hospital complaining of fever, cough, and sore throat for 4 days. Although chronic ITP was controlled by 12.5 mg of eltrombopag (EPAG) every other day, laboratory tests showed a decreased peripheral blood platelet count of 15.0 × 109/L, which indicated worsening thrombocytopenia. Meanwhile, PCR testing of a nasopharyngeal swab revealed that the patient was positive for SARS-Cov-2, and a computed tomography scan revealed bilateral pneumonia. On the basis of the flare-up of chronic ITP associated with COVID-19 pneumonia which was determined as a moderately severe status according to the WHO clinical progression scale, intravenous immunoglobulin therapy for 5 days (days 0– 4) and antiviral therapy were added on top of EPAG, which only resulted in a transient increase in the platelet count for several days. After decreasing to 8.0 × 109/L on day 13, the platelet count increased from day 16, coinciding with a positive detection for serum nAb against SARS-Cov-2. Although the increased dose up to 50 mg/day of EPAG was challenged during the clinical course, rapid dose reduction did not cause another relapse. In addition, no thrombotic or bleeding event was seen. These collectively suggest the vital role of the production of anti-SARS-Cov-2 nAb and improvement of clinical symptoms for recovery from a flare-up of chronic ITP in our case.Keywords: chronic immune thrombocytopenia, COVID-19, flare, neutralizing antibody

Keywords