SHM Converge Scientific Abstract ePoster Gallery-Unmasking Covid Sequale: A Recurrence of Evan's Syndrome

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This case report describes a relapse of Evans syndrome triggered by acute SARS-CoV-2 infection in a 27-year-old man with a remote childhood history of the disorder and no prior recurrence. Evans syndrome is a rare autoimmune condition characterized by the combination of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP), and it may be primary or secondary to conditions such as malignancy, autoimmune disease, or viral infection.<br /><br />The patient presented with several days of fatigue, scleral icterus, and a recent nonproductive cough. Initial evaluation showed severe anemia (hemoglobin 5.3 g/dL), marked thrombocytopenia (10,000/µL), and indirect hyperbilirubinemia. Additional hemolysis studies revealed elevated LDH and undetectable haptoglobin. Peripheral smear showed spherocytes without schistocytes, making thrombotic thrombocytopenic purpura unlikely. Direct antiglobulin testing was positive for IgG, confirming warm autoimmune hemolytic anemia. A broad workup for other causes was negative except for a positive SARS-CoV-2 PCR test.<br /><br />He was treated initially with dexamethasone and IVIG, then given rituximab and high-dose prednisone because of concern for Evans syndrome relapse and to improve long-term remission. His blood counts improved steadily, with hemoglobin rising to 9.2 g/dL and platelets to 173,000/µL by hospital day 10. He was discharged in stable condition and completed four weekly rituximab infusions with steroid taper.<br /><br />The authors emphasize that COVID-19 can be associated with severe autoimmune hematologic complications, including relapse of Evans syndrome, and that diagnosis may remain uncertain while awaiting full laboratory evaluation. They also note that proposed mechanisms such as molecular mimicry may help explain COVID-related AIHA, but the relationship with ITP remains unclear.

Asset Subtitle

Daniel W. Shields Jr.

Meta Tag

Author List Daniel W. Shields Jr., John Blaine Moore, Pete Beale

Category Clinical Vignettes

Concept Evans Syndrome

Concept Autoimmune Hemolytic Anemia

Concept Immune Thrombocytopenia

Concept Anemia

Concept Thrombocytopenia

Distinguished Non-Finalist

Presenter Organization Naval Medical Center Portsmouth

Presenting Author Daniel W. Shields Jr.

Track Adult

Keywords

Evans syndrome

SARS-CoV-2 infection

COVID-19

autoimmune hemolytic anemia

immune thrombocytopenia

relapse

rituximab

dexamethasone

intravenous immunoglobulin

molecular mimicry

Evans Syndrome

Autoimmune Hemolytic Anemia

Immune Thrombocytopenia

Anemia

Thrombocytopenia