SHM Converge Scientific Abstract ePoster Gallery-Covid-19 and Levofloxacin: A Pernicious Combination for Immune Thrombocytopenic Purpura

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This case report describes a 72-year-old woman with coronary artery disease, COPD, and recent COVID-19 pneumonia who presented with epistaxis and petechiae. Her evaluation showed severe thrombocytopenia with a platelet count of 2,000, anemia, elevated D-dimer and LDH, but negative testing for HIT, hepatitis C, HIV, and ADAMTS13 deficiency. Vitamin B12 and folate were normal, and peripheral smear showed markedly decreased but morphologically normal platelets without clumping or schistocytes, supporting immune thrombocytopenic purpura (ITP) rather than marrow failure or microangiopathic hemolysis.<br /><br />She was treated with IVIG and high-dose steroids, with improvement in platelet count. The authors highlight that ITP can occur as an extrapulmonary complication of COVID-19, potentially related to endothelial damage, platelet consumption in the lungs, bone marrow suppression, and altered immune clearance. They also note that levofloxacin, which the patient had recently received, is a known cause of drug-induced immune thrombocytopenia (DITP). Proposed mechanisms for DITP include drug-dependent platelet antibodies, hapten-mediated responses, autoantibody formation, and immune complex formation.<br /><br />The report suggests that this patient’s ITP may have resulted from the combined prothrombotic and immune dysregulating effects of COVID-19 plus recent levofloxacin exposure. The case emphasizes the importance of considering both infection-related and medication-related causes when evaluating acute severe thrombocytopenia in patients recovering from COVID-19.

Asset Subtitle

Fateeha Tariq

Meta Tag

Author List Adnan Liaqat, Brian Foster, Bsmah Amar S. Abdalslam, Fateeha Tariq, Jose F Ramirez, Qamar Gulzar, Ramesh Swamiappan

Category Clinical Vignettes

Concept Immune Thrombocytopenia

Concept Drug-Induced Immune Thrombocytopenia

Concept Thrombocytopenia

Concept Intravenous Immunoglobulin

Concept High-Dose Corticosteroid

Distinguished Non-Finalist

Presenter Organization Southeast Health

Presenting Author Fateeha Tariq

Track Adult

Keywords

immune thrombocytopenic purpura

COVID-19 pneumonia

severe thrombocytopenia

levofloxacin

drug-induced immune thrombocytopenia

IVIG

high-dose steroids

epistaxis

petechiae

platelet count

Immune Thrombocytopenia

Drug-Induced Immune Thrombocytopenia

Thrombocytopenia

Intravenous Immunoglobulin

High-Dose Corticosteroid