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

Figures & data

Figure 1 Computed tomography (CT) scan of the chest on admission. The CT scan showed frosted glass shadows and partial dense infiltration in bilateral lungs.

Figure 2 Clinical course of the patient after hospitalization. The crosses indicate neutralizing antibody (nAb) titers, and the dashed line indicates the cutoff value for nAb. IVIg, intravenous immunoglobulin therapy.

Table 1 Clinical Features of the 13 Cases of Chronic ITP Flare-Up Associated with COVID-19 Infection, Including the Present Case

No.	Age	Gender	COVID-19 Severity	Nadir PLT Count (×10^9/L)	Treatment at COVID-19 Onset	Added Treatment for Relapse	PLT Count at Discharge or After Treatment (×10^9/L)	Prophylactic Anticoagulant	Thrombosis	Hospitalization Length (Days)	Ref.
1	88	M	Moderate	8	None	None	13	None	No	4	[4]
2	89	F	Mild	8	ROMI, MMF	IVIg	N.A.	None	No	N.A.
3	50	M	Moderate	18	PSL	IVIg	28	Yes	No	21
4	72	M	Mild	23	None	PSL	180	Yes	No	N.A.
5	20	F	Mild	26	None	None	26	None	No	1
6	54	F	Moderate	26	None	DEX	105	Yes	No	4
7	38	F	Mild	94	None	None	N.A.	None	No	N.A.
8	38	F	Moderate	112	PSL	None	236	None	No	3
9	61	M	Moderate	137	Rituximab	None	346	None	Pulmonary embolus, DVT	7
10	53	F	Mild	158	EPAG	None	158	None	Cerebral venous sinus thrombosis	2
11	37	F	N.A.	6	MMF	IVIg, mPSL	119	None	No	11	[5]
12	72	F	N.A.	18	PSL, CsA	IVIg, mPSL	240	None	No	N.A.	[6]
13	79	F	Moderate	8	EPAG	IVIg, EPAG	183	Yes	No	20	Our case

Notes: The severity of COVID-19 infection was determined as follows: “mild” indicates asymptomatic or not requiring oxygen therapy; “moderate” requires oxygen therapy on hospitalization; and “severe” requires ventilator management or ICU management.

Abbreviations: CsA, cyclosporine; DEX, dexamethasone; DVT, deep venous thrombosis; EPAG, eltrombopag; F, female; IVIg, intravenous immunoglobulin; M, male; MMF, mycophenolate mofetil; mPSL, methylprednisolone; PSL, prednisone or its analogue; ROMI, romiplostim; Ref, reference; N.A., not available.

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