scholarly journals Immune thrombocytopenic purpura and acute liver injury after COVID-19 vaccine

2021 ◽  
Vol 14 (7) ◽  
pp. e242678
Author(s):  
Adam Hines ◽  
Janice Gloria Shen ◽  
Coral Olazagasti ◽  
Shakil Shams
Keyword(s):  
Primary Care ◽  
Immune Thrombocytopenic Purpura ◽  
Temporal Relationship ◽  
Liver Enzymes ◽  
Acute Liver Injury ◽  
Care Physician ◽  
Thrombocytopenic Purpura ◽  
Intravenous Steroids ◽  
Relationship Of ◽  
Suspected Diagnosis

A 26-year-old woman was sent to the emergency room by her primary care physician for a new petechial rash and thrombocytopenia 2 weeks after receiving the Moderna mRNA-1273 SARS-CoV-2 vaccine. Her hospital course was complicated by transaminitis. Her platelet count improved to normal on hospital day 5 after receiving intravenous steroids and intravenous immunoglobulin to treat her suspected diagnosis of immune thrombocytopenic purpura. Extensive workup for her thrombocytopenia and transaminitis was unremarkable including ruling out infectious, autoimmune and toxic causes. A liver biopsy was unrevealing and her transaminitis was improved on discharge. Although not proven, the temporal relationship of her vaccination with thrombocytopenia and abnormal liver enzymes points towards the Moderna mRNA-1273 SARS-CoV-2 vaccine as the most likely inciting factor.

Severe haematological complications during treatment with natalizumab

2012 ◽  
Vol 18 (11) ◽  
pp. 1644-1646 ◽  
Author(s):  
L Midaglia ◽  
M Rodriguez Ruiz ◽  
D Muñoz-García
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Immune Thrombocytopenic Purpura ◽  
Safety Profile ◽  
Temporal Relationship ◽  
Careful Monitoring ◽  
Thrombocytopenic Purpura ◽  
Immune Mediated ◽  
Immunosuppressant Treatment

The safety profile of natalizumab has been widely discussed due to several cases of progressive multifocal leukoencephalopathy, reported worldwide. Since the launch of natalizumab, 32 patients have been treated at our centre. In this context, we describe two cases (6.25%), one of immune-mediated acute haemolytic anaemia (IAHA) and another of immune thrombocytopenic purpura during treatment with natalizumab. The temporal relationship between drug administration and the nature of the haematological complications, confirmed with the serological findings in the case of the IAHA, suggests that natalizumab is the most probable cause for these adverse events. Although very uncommon, the haematological complications are severe enough to justify a close and careful monitoring for all patients with multiple sclerosis treated with an immunosuppressant treatment.

Viral-Associated Immune Thrombocytopenic Purpura

Hematology ◽  
2008 ◽  
Vol 2008 (1) ◽  
pp. 212-218 ◽  
Author(s):  
Howard A. Liebman
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Immune Thrombocytopenic Purpura ◽  
Highly Active Antiretroviral Therapy ◽  
Chronic Infection ◽  
Liver Enzymes ◽  
De Novo ◽  
Thrombocytopenic Purpura ◽  
Highly Active ◽  
Immunodeficiency Virus

Abstract Chronic immune thrombocytopenic purpura (CITP) is a diagnosis of exclusion that occurs either de novo or secondary to other underlying disorders. Chronic infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are now well-characterized causes of CITP. Between 6% and 15% of patients infected with HIV may develop thrombocytopenia. Patients with CITP with risk factors for HIV infection should be screened for the virus. Treatment of HIV-related CITP should be directed toward antiviral therapy with highly active antiretroviral therapy (HAART) regimens. Hepatitis C viral infection can also be associated with chronic thrombocytopenia, even in the absence of overt liver disease. While HCV-related thrombocytopenia is typically less severe than primary CITP, affected patients are at greater risk of major bleeding. Sustained suppression of HCV virus with interferon-ribavirin therapy can improve platelet counts. Screening for HCV infection should be considered in patients with ITP with risk factors for infection, from regions with high rates of infection or in patients with unexplained mild elevations of liver enzymes.

scholarly journals Recurrent venous and arterial thrombosis during anticoagulant treatment in a patient with immune thrombocytopenic purpura exacerbation

2020 ◽  
Vol 30 (2) ◽  
pp. 257-262
Author(s):  
Georgiana Poparlan ◽  
Mirela Mihaela Mihalcia ◽  
Ovidiu Mitu ◽  
Cristina Tarniceriu ◽  
Cristian Statescu ◽  
...  
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Arterial Thrombosis ◽  
Rare Case ◽  
Platelet Transfusion ◽  
Multidisciplinary Approach ◽  
Coronary Intervention ◽  
Thrombocytopenic Purpura ◽  
Recurrent Venous Thromboembolism ◽  
Percutaneous Coronary ◽  
Intravenous Steroids

Treatment of patients with immune thrombocytopenic purpura (ITP) associated with recurrent venous and arterial thrombosis can represent a major challenge. We present the rare case of a 56-year-old female who was first diagnosed with severe ITP at the age of 36. She required corticosteroid therapy and splenectomy in evolution. However, in the last three years she had several episodes of recurrent venous thromboembolism for which she required different anticoagulant therapies despite severe thrombocythemia. The patient also developed acute myocardial infarction treated by primary percutaneous coronary intervention that was complicated with acute intrastent thrombosis. Thus, maximal antiplatelet therapy was mandatory. For ITP, the patient received intravenous steroids, platelet transfusion as well as eltrombopag. Moreover, the patient also suffered from a haemorrhagic uterine fibroma that required surgery. Thus, a close multidisciplinary approach was needed for the successful treatment of this patient.

Concurrent terbinafine-induced acute generalised exanthematous pustulosis and hepatitis

2021 ◽  
Vol 14 (1) ◽  
pp. e238930 ◽  
Author(s):  
Lorenzo R Carnio ◽  
Mary E Johnson Shaw ◽  
Jack Schnur ◽  
Damian Casadesus
Keyword(s):  
Primary Care ◽  
Side Effects ◽  
Primary Care Physician ◽  
Liver Enzymes ◽  
Care Physician ◽  
Medical Community ◽  
Left Flank ◽  
Elevated Liver Enzymes ◽  
Laboratory Results ◽  
Exanthematous Pustulosis

Terbinafine is a commonly used antifungal medication. Its side effects, while widely known, are rarely described and can be missed by the medical community. We present a 55-year-old woman who visited her primary care physician with onychomycosis. She started treatment with terbinafine, and 1 week later developed a rash in the left flank that extended to the chest, back, and upper part of lower extremities. Laboratory results showed elevated liver enzymes. A treatment with steroids did not improve the rash and she was admitted to our institution. She was started with intravenous dexamethasone, topical hydrocortisone and triamcinolone. Seven days later the liver enzymes normalised, and the rash resolved on the chest and back. Our patient had concurrent acute generalised exanthematous pustulosis and hepatitis that together has been very rarely associated with terbinafine.

Romiplostim for management of refractory immune thrombocytopenic purpura in the immediate postpartum period

2020 ◽  
Vol 13 (5) ◽  
pp. e234335
Author(s):  
Ariana Patras ◽  
Reinaldo Figueroa ◽  
Amit P Singh ◽  
Ichchha Madan
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Postpartum Period ◽  
Liver Enzymes ◽  
High Dose ◽  
Chronic Hypertension ◽  
First Line ◽  
Diagnostic Dilemma ◽  
Thrombocytopenic Purpura ◽  
Thrombopoietin Receptor ◽  
Thrombopoietin Receptor Agonist

We present a case of a pregnant woman with chronic immune thrombocytopenic purpura and chronic hypertension who developed pre-eclampsia with severe features warranting delivery. Her overall clinical picture and liver enzymes improved in the immediate postpartum period, however, aggressively progressing thrombocytopenia posed a diagnostic dilemma to the interdisciplinary care team. After failing to respond to first-line therapies including high-dose corticosteroids and intravenous immunoglobulin, she was successfully managed with a trial of the thrombopoietin receptor agonist, Romiplostim.

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