COVID-19 presenting as thrombotic thrombocytopenic purpura (TTP)
COVID-19 presenting as thrombotic thrombocytopenic purpura (TTP)
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DOI：
10.1136/bcr-2020-238026
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发表时间：
2020-12-01
期刊：
影响因子：
0.9
通讯作者：
Alkathlan, Mohammed
中科院分区：
文献类型：
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作者：
Altowyan, Essam;Alnujeidi, Omar;Alkathlan, Mohammed
我们报告一位39岁男性，主诉上腹痛、恶心及呕吐。该患者在急性呼吸道症状视觉分诊检查表中评分为4分;采集了COVID-19拭子。外周血涂片检查提示微血管病性溶血性贫血和血小板减少症。由于患者有血栓性血小板减少性紫癜的图片，立即开始血浆置换和皮质类固醇。3天后，他发生了严重的缺血性中风，通过逆转录PCR，他的拭子对COVID-19呈阳性。因此，开始三联治疗（洛匹那韦/利托那韦、利巴韦林和干扰素β-1b）。白色血细胞计数达到50 × 10（9）/L（正常范围，4.5- 11 × 10（9）/L），主要是中性粒细胞。所有自身免疫性疾病的检查结果都是阴性。患者表现出乳酸脱氢酶、血红蛋白和血小板计数的延迟改善，直到我们增加血浆置换量并平息COVID-19的炎症反应。之后，患者恢复良好。
We present the case of a 39-year-old man with epigastric pain, nausea and vomiting. The patient scored 4 in the Visual Triage Checklist of acute respiratory symptoms; a COVID-19 swab was taken. Prompt review of the peripheral blood smear showed evidence of microangiopathic haemolytic anaemia and thrombocytopenia. Because the patient had a picture of thrombotic thrombocytopenic purpura, plasma exchange and corticosteroids were started immediately. After 3days, he developed severe ischaemic stroke and his swabs came back positive for COVID-19 by reverse transcription PCR. Therefore, triple therapy was started (lopinavir/ritonavir, ribavirin and interferon beta-1b). White blood cell count reached 50x10(9)/L (normal range, 4.5-11x10(9)/L), mainly neutrophils. All the workup for autoimmune diseases was negative. The patient showed delayed improvement in lactate dehydrogenase, haemoglobin and platelet count until we increased the volume of plasma exchange and subsided the inflammatory response of COVID-19. After that, the patient showed an excellent recovery.