A Rare Presentation of COVID-19 Associated Thrombotic Thrombocytopenic Purpura; Therapeutic Challenges

Eman EL-Sawalhy^1, , Hammam Shereef², Hana Manzoor², Fadi Abuhmaid³ and Shahina Patel⁴

¹Department of Internal Medicine, Beaumont Hospital, Dearborn, MI

²Department of Internal Medicine, Beaumont Health-Dearborn, 18101 Oakwood Blvd. Dearborn, MI

³Division of Nephrology, Internal Medicine Department, Beaumont Hospital, Dearborn, MI

⁴Division of Hematology & Oncology, Internal Medicine Department, Beaumont Hospital, Dearborn, MI

Cite this paper:
Eman EL-Sawalhy, Hammam Shereef, Hana Manzoor, Fadi Abuhmaid and Shahina Patel. A Rare Presentation of COVID-19 Associated Thrombotic Thrombocytopenic Purpura; Therapeutic Challenges. American Journal of Medical Case Reports. 2021; 9(3):147-149. doi: 10.12691/ajmcr-9-3-3

Abstract

Since COVID-19 has been declared a global pandemic, variable clinical presentations have been reported, most commonly with respiratory symptoms and less commonly gastrointestinal or neurological symptoms. Hematologic disorders in the form of thrombotic microangiopathies (TMA) such as immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and microangiopathic hemolytic anemia (MAHA) were also linked to the COVID-19 positive population. Many studies have proposed several possible theories, including viral-mediated, endothelial related, immune triggered, and consumptive mechanisms. In most of the literature, the severity of the disease is associated with more severe thrombocytopenia, with lower levels being associated with higher mortality. We herein report a case of a patient who tested positive for COVID-19 and went on to develop severe thrombocytopenia. Workup of the thrombocytopenia revealed that he had developed acquired Thrombotic thrombocytopenic purpura (TTP). Our case report highlights the need for early recognition, prompt diagnosis, and the subsequent initiation of urgent treatment.

Keywords:
COVID-19 TTP

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