Presenting symptoms
Petechiae and nasal bleeding were discovered in a 41-year-old man. 15 days ago, he had a cough and a runny nose, which went away recently. After four days of ineffective high-dose dexamethasone treatment, he was diagnosed with Immune thrombocytopenic purpura (ITP) and referred to a doctor. He had an unremarkable medical background.
Physical examination
Physical examination was normal except for petechiae and purpuric rash.
He had isolated thrombocytopenia (9 x 109 /L) when he was admitted. The patient did not have ingestion coagulopathy or thrombotic microangiopathy in the differential diagnosis of isolated thrombocytopenia, and there were no schistocytes or blasts in the peripheral blood smear.
Laboratory Tests
The diagnosis of ITP was made after laboratory tests including a viral hepatitis panel and rheumatological markers revealed no cause of thrombocytopenia. A nasopharyngeal swab was sent for extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real time polymerase chain reaction (RT-PCR), which came back positive, since he had cough and runny nose recently.
Diagnosis
His chest computerized tomography showed bilateral ground glass opacities consistent with COVID-19 pneumonia.
Medications
The antiviral drug Favipiravir was prescribed, and his pneumonia cleared up in five days. In the first two days of admission, intravenous immunoglobulin (IVIg) with a total dose of 2 g/kg was given concurrently with Favipiravir, as ITP secondary to COVID-19 was the most likely diagnosis. His platelet count was 54 x 109 /L after surgery, and platelet counts ranged from 50 to 100 x 109 /L during the 4-week follow-up period.
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