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Alahwal HM, Alsharif MH, Alsharif MH, Almohammadi AT, Al-Marzouki AF, Barefah AS, Bahashwan SM, Radhwi OO, Damanhouri GA. COVID-19-induced immune thrombocytopenia management approach: A case report and literature review. Clin Case Rep 2024; 12:e9070. [PMID: 38883219 PMCID: PMC11176723 DOI: 10.1002/ccr3.9070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/11/2024] [Accepted: 05/25/2024] [Indexed: 06/18/2024] Open
Abstract
Key Clinical Message Vincristine therapy can be effective in refractory Immune thrombocytopenia (ITP) following COVID-19 vaccination. Our case report highlights the need for further research to establish standard management guidelines for COVID-19-vaccine-associated ITP. Abstract Adult immune thrombocytopenia (ITP) can occur as a rare complication following several viral infections or a rare adverse event or complication of vaccination. In this paper, we report a case of a 39-year-old male patient with severe refractory ITP that began 4-weeks after receiving his third (booster) dose of the COVID-19 vaccine (BNT162b2, Pfizer-BioNTech). He was given oral dexamethasone 40 mg daily for 4 days followed by prednisone at 1 mg/kg (85 mg daily) for 10 days. In the following weeks, we attempted several other lines of therapy to treat his ITP, including anti-RhD immunoglobulin, which, unfortunately, caused moderate hemolysis requiring packed red blood cell transfusion, intravenous immunoglobulin (given at a subtherapeutic dose of 0.4 g/kg for only 1 day since it was not available), rituximab, and eltrombopag. The patient, unfortunately, showed no response to any of these treatments. This was an indicator to initiate salvage therapy with vincristine 2 mg weekly for 3 weeks. The patient's platelet count started to increase remarkably during the third week of vincristine and normalized after 4 weeks. We review the findings, clinical characteristics, and management approaches that were reported in the literature regarding COVID-19-vaccine-induced ITP. More in-depth research is needed to delineate standard guidelines for the management of such cases. This report underscores the importance of resorting to vincristine and eltrombopag as great options for severe and refractory ITP related to the COVID-19 vaccine.
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Affiliation(s)
- Hatem Mahmoud Alahwal
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
| | | | - Mada Hani Alsharif
- Department of Preventive Medicine - Directorate of Health Affairs Jeddah Saudi Arabia
| | - Abdullah Talal Almohammadi
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
| | - Adel Fahad Al-Marzouki
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
| | - Ahmed Saleh Barefah
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
| | - Salem Mohammad Bahashwan
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
| | - Osman Omer Radhwi
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
| | - Ghazi Abdullah Damanhouri
- Hematology Department, Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia
- Hematology Research Unit, King Fahd Medical Research Center King Abdulaziz University Jeddah Saudi Arabia
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Ogasawara N, Matsunaga K, Isomoto H, Shimizu W. Internal Medicine Year in Review 2022. Intern Med 2023; 62:3431-3435. [PMID: 37286505 PMCID: PMC10749803 DOI: 10.2169/internalmedicine.2266-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023] Open
Abstract
A novel coronavirus infection [coronavirus disease 2019 (COVID-19)] became a global epidemic just months after the first case of infection was reported in Wuhan, China in December 2019. Its spread has severely affected social systems and people's lives. In the academic world, this led to an increase in the number of papers submitted to this journal. While the number of articles submitted to the journal reached a record high in 2020, the number of articles submitted last year returned to prepandemic levels. In this article, we report on the current submission conditions, including the number of submissions and acceptance rate, as well as the citation trends of highly cited articles and those published by the journal in 2022.
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Affiliation(s)
- Naruaki Ogasawara
- Editorial Department, The Japanese Society of Internal Medicine (JSIM), Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Hajime Isomoto
- Department of Multidisciplinary Internal Medicine, Tottori University, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
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Lee ZM, Chen YC, Liu SC, Wang CC. Immune thrombocytopenia following SARS-CoV-2 vaccination in a female: Report of one case. Pediatr Blood Cancer 2023; 70:e30211. [PMID: 36726145 DOI: 10.1002/pbc.30211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Yu-Chieh Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Traditional Medicine, Chang Gung University, Linkou, Taiwan
| | - Shu-Chen Liu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Chen Wang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Bidari A, Asgarian S, Pour Mohammad A, Naderi D, Anaraki SR, Gholizadeh Mesgarha M, Naderkhani M. Immune thrombocytopenic purpura secondary to COVID-19 vaccination: A systematic review. Eur J Haematol 2023; 110:335-353. [PMID: 36562217 PMCID: PMC9880659 DOI: 10.1111/ejh.13917] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This systematic review aimed to retrieve patients diagnosed with de novo immune thrombocytopenic purpura (ITP) after COVID-19 immunization to determine their epidemiological characteristics, clinical course, therapeutic strategies, and outcome. MATERIALS AND METHODS We conducted the review using four major databases, comprising PubMed, Scopus, Web of Science, and the Cochrane library, until April 2022. A systematic search was performed in duplicate to access eligible articles in English. Furthermore, a manual search was applied to the chosen papers' references to enhance the search sensitivity. Data were extracted and analyzed with the SPSS 20.1 software. RESULTS A total of 77 patients with de novo COVID-19 vaccine-associated ITP were identified from 41 studies, including 31 case reports and 10 case series. The median age of patients who developed COVID-19 vaccine-associated ITP was 54 years (IQR 36-72 years). The mRNA-based COVID-19 vaccines, including BNT16B2b2 and mRNA-1273, were most implicated (75.4%). Those were followed by the adenovirus vector-based vaccines, inclusive of ChAdOx1 nCoV-19 and vAd26.COV2.S. No report was found relating ITP to other COVID-19 vaccines. Most cases (79.2%) developed ITP after the first dose of COVID-19 vaccination. 75% of the patients developed ITP within 12 days of vaccination, indicating a shorter lag time compared to ITP after routine childhood vaccinations. Sixty-seven patients (87%) patients were hospitalized. The management pattern was similar to primary ITP, and systemic glucocorticoids, IVIg, or both were the basis of the treatment in most patients. Most patients achieved therapeutic goals; only two individuals required a secondary admission, and one patient who presented with intracranial hemorrhage died of the complication. CONCLUSIONS De novo ITP is a rare complication of COVID-19 vaccination, and corresponding reports belong to mRNA-based and adenovirus vector-based vaccines, in order of frequency. This frequency pattern may be related to the scale of administration of individual vaccines and their potency in inducing autoimmunity. The more the COVID-19 vaccine is potent to induce antigenic challenge, the shorter the lag time would be. Most patients had a benign course and responded to typical treatments of primary ITP.
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Affiliation(s)
- Ali Bidari
- Department of Rheumatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Asgarian
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Arash Pour Mohammad
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Delaram Naderi
- Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | | | - Mahya Naderkhani
- Department of Emergency medicine, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Han Q, Han J, Wang W, Gao J, Qiao Y, Jia J, Zhang K, Zheng Z, Zhu P. Case report: Kimura's disease with minimal degenerative glomerulopathy without eosinophil infiltration responds to mycophenolate mofetil treatment. Front Med (Lausanne) 2023; 9:1069553. [PMID: 36698834 PMCID: PMC9868591 DOI: 10.3389/fmed.2022.1069553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Kimura's disease (KD) is a rare chronic progressive immune inflammatory disease. The etiology is unknown and manifests as a chronic inflammatory process, which is more common in young Asian men. The clinical manifestations are painless subcutaneous swelling of the head and neck and periauricular lymphadenopathy, which is slow growing and has a benign course. KD may involve the kidney, and pathological examination revealed eosinophil infiltration in the renal tissue. Proteinuria has been reported in 12-16% of KD cases, and about 60-70% of KD patients will develop nephrotic proteinuria. KD is easily confused with nephrotic syndrome, because KD does not have specific clinical manifestations, laboratory and imaging, and early misdiagnosis is easy. We report a case of KD that was biopsy-proven to have minimal lesion glomerulopathy after ~11 years. In this report, we describe a clinical case of KD with nephrotic syndrome, but there's no eosinophil infiltration in the kidneys. The clinical manifestations of KD recurrence were bilateral eyelid edema, bilateral lower limb swelling, and massive proteinuria in response to mycophenolate mofetil treatment (1.5 g).
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Affiliation(s)
- Qing Han
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Jie Han
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Weitao Wang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Jie Gao
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Youzhen Qiao
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Junfeng Jia
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China,*Correspondence: Zhaohui Zheng ✉
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China,National Translational Science Center for Molecular Medicine, Xi'an, Shaanxi, China,Ping Zhu ✉
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Feng Y, Quan Y, Cassady K, Zou Z, Gao Y, Zhang X. Clinical characteristics in immune thrombocytopenia patients after COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2119043. [PMID: 36069667 PMCID: PMC9746405 DOI: 10.1080/21645515.2022.2119043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
It is well documented that COVID-19 vaccines greatly reduce the severity and complications of SARS-CoV-2 infection. However, it has been reported that COVID-19 related vaccines may induce or exacerbate autoimmune hematological disorders, for example, a decrease in platelet numbers characteristic of immune thrombocytopenia (ITP). To investigate this, we retrospectively reported, for the first time, the clinical characteristics of 42 ITP patients after COVID-19 vaccination in southwest China. Of the 42 patients, 28 patients were historically diagnosed ITP, and their platelet counts (PC) decrease mainly occurred after the first-dose vaccinations. The average PC after vaccination was 39.5 × 109/L and recovered to an average of 80.6 × 109/L after treatment. Efficacy of treatment was 90%, and only 10% maintained low PC at the third month of treatment. More interestingly, of the 42 patients, 14 were newly diagnosed ITP following vaccination. Of these 14 patients, 6 patients (43%) were found PC deterioration after the first vaccine dose, and 7 patients (50%) after the second dose. Fortunately, the peripheral PC of all 14 patients recovered significantly after treatment, and the average PC was 139.4 × 109/L, including 8 CRs (complete response) and 6 PRs (partial response). Notably, 9 of the 14 cases were found to have abnormal immune indices when thrombocytopenia diagnosed. No severe organ hemorrhage was found in either subgroup. These results are reassuring the vaccine safety for ITP patients, in that the risks of aggravating thrombocytopenia by COVID-19 vaccination do exist, but it was transient and can be effectively controlled through intensive clinical monitoring and management.
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Affiliation(s)
- Yimei Feng
- Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, Chongqing, China,CONTACT Yimei Feng
| | - Yao Quan
- Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, Chongqing, China
| | | | - Zhongmin Zou
- Department of Chemical Defense Medicine, School of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Yuan Gao
- Department of Neonatology, Maternal and Child Health Service Hospital, Chongqing, China
| | - Xi Zhang
- Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, Chongqing, China,Xi Zhang Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, 183 Xinqiao Street, Shapingba District, Chongqing400037, China
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Isaac S, Pasha MA, Yadav U. Immune Thrombocytopenia Following COVID-19 Vaccination. Intern Med 2022; 61:2827. [PMID: 35831105 PMCID: PMC9556221 DOI: 10.2169/internalmedicine.0372-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sangeetha Isaac
- Department of Internal Medicine, North Alabama Medical Center, United States of America
| | - Mohammed Afraz Pasha
- Department of Internal Medicine, North Alabama Medical Center, United States of America
| | - Udit Yadav
- Department of Hematology & Oncology, North Alabama Medical Center, United States of America
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A Systematic Review of Reported Cases of Immune Thrombocytopenia after COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10091444. [PMID: 36146522 PMCID: PMC9500907 DOI: 10.3390/vaccines10091444] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
With the recent outbreak of the COVID-19 pandemic and emergency use authorization of anti-SARS-CoV-2 vaccines, reports of post-vaccine immune thrombocytopenia (ITP) have gained attention. With this systematic review, we aim to analyze the clinical characteristics, therapeutic strategies, and outcomes of patients presenting with ITP after receiving COVID-19 vaccination. Medline, Embase, and Ebsco databases were systematically explored from inception until 1 June 2022. Case reports and case series investigating the association between the anti-SARS-CoV-2 vaccine and ITP were included. We found a total of 66 patients. The mean age of presentation was 63 years with a female preponderance (60.6%). Sixteen patients had pre-existing ITP. The mean time from vaccine administration to symptom onset was 8.4 days. More ITP events were triggered by mRNA vaccines (BNT162b2 (n = 29) > mRNA-1273 (n = 13)) than with adenoviral vaccines (ChAdOx1-S AstraZeneca (n = 15) > Ad26.COV2-S (n = 9)). Most of the patients were treated with steroids or IVIG, or both. The overall outcome was promising, with no reported deaths. Our review attempts to increase awareness among physicians while evaluating patients presenting with thrombocytopenia after receiving the vaccine. In our solicited opinion, the rarity of these events and excellent outcomes for patients should not change views regarding the benefits provided by immunization.
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Elasomeran/tozinameran. REACTIONS WEEKLY 2022. [PMCID: PMC9184324 DOI: 10.1007/s40278-022-17041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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