From: Evan syndrome as initial presentation of COVID-19 infection
Author | Month | Country | History of the patient | Clinical presentations | Timing of the hematologic presentations | Autoimmune disorder | Treatment | Outcome |
---|---|---|---|---|---|---|---|---|
Li et al. [12] | Late March 2020 | USA | 39-year-old male | First admission: fever, chills, dyspnea, hemoptysis, epistaxis, sore throat, productive cough, tachycardia, tachypnea, oral blood blister, hematemesis, melena, hematochezia and no petechiae, ecchymosis or rash Second admission (10 days later, 4 days after first discharge): intermittent fever,cough, extreme weakness, fatigue, and no bleeding | About 7 days | Evans syndrome | First admission: proton pump inhibitor, IVIG Second admission: IVIG | Recovered (in first admission that patient had ITP, resolution of bleeding and raise of Plt occurred on day 5 and the patient was discharged on day 6; Hb drop also responded to IVIG in second admission) |
Wahlster et al. [13] | April 2020 | USA | 17 -year-old male K/C of refractory chronic ITP on eltrombopag and mycophenolate mofetil | Fever, fatigue, emesis, diarrhea, progressive jaundice, marked pallor, tachycardia, tachypnea, and hypoxemia | 4 days | Evans syndrome | Steroid, packed cell transfusion | Recovered (Hb became stable within 48 h of steroid administration) |
Vadlamudi et al. [14] | June 2020 | USA | 23-year-old female gravida 2, para 1, at 38 weeks of pregnancy in active labor | Spontaneous rupture of membranes, contractions, blood-tinged discharge, history of ecchymosis and an episode of epistaxis 2 weeks prior, no pallor, ecchymosis or organomegaly On day 38 of postpartum: chest pain and shortness of breath | Not clear | Evans syndrome | IV iron dextran, IVIG, rituximab, dexamethasone, packed cell and Plttransfusion, folate (1 mg daily) and B12 (1000 mcg monthly) | Recovered |
Demir et al [15] | April 26, 2020 | Turkey | A 22-year-old male patient | Jaundice, weakness, shortness of breath, fever, tachycardia, tachypnea, O2 sat: 89%; and body mass index: 32.5, icteric sclerae, pale conjunctivae. | Not clear | Evans syndrome | Patient was treated with hydroxychloroquine, moxifloxacin and favipiravir for 5 days, Subcutaneous enoxaparin 1 × 0.6 cc, continuous positive airway pressure was administered intermittently, Methylprednisolone 1 mg/kg, folic acid, vitamin B12, and a proton pump inhibitor, 2 units of erythrocyte suspension daily, intravenous immunoglobulin (IVIG) 1 g/kg/day. | Recovered (on day 5 after discharge from hospital, his hemoglobin was 13 g/dL and his platelet count was 210 × 109 /L. Furthermore, his rapid antibody test (serological test) was positive for IgM and IgG against SARS-CoV 2). |
Zarza et al [16] | March 23, 2020 | Paraguay | A 30-year-old woman | At the time of her first visit March 23rd 2020, she presented with upper respiratory symptoms, nasal congestion, a sore throat, a cough, and the loss of her taste and smell. Medical history for a deep venous thrombosis of the right lower limb that she experienced when she was 11 years old. On April 1st, 2020, gingivorrhagia, which was self-limited. On April 5th, incoercible epistaxis appeared, Petechiae were found on her skin all over her body. | About 10 days | Evans syndrome | 1 g of methylprednisolone intravenously (IV) each day for three consecutive days was started, resulting in a decrease in bleeding and purpura. Empirical treatment was started with 500 mg of azithromycin PO on day 1 followed by 250 mg per day for 4 days, 400 mg of hydroxychloroquine PO every 12 h on day 1 followed by 200 mg PO every 12 h for the next 4 days, 100 mg of prednisone PO once daily, and 1 g of ceftriaxone IV every 24 h. enoxaparin at prophylactic doses of 40 mg every 24 h. She was discharged with 50 mg of prednisone daily, 200 mg of hydroxychloroquine every 12 h, and 40 mg of enoxaparin daily. A close follow-up was indicated by all of the specialists involved in her care. | The progressive improvement of the patient’s health permitted her to be sent home. |
Barcellini et al. [17] | March 25, 2020 | Italy | 78-year-old male | On March 25, 2020, he presented at the outpatient clinic with typical symptoms of COVID-19 pneumonia (fever, dyspnoea, desaturation to 80%). His past medical history consisted of arterial hypertension, previous myocardial infarction with ventricular fibrillation, stroke, two septic shocks, and osteonecrosis of the femoral head. | Not mentioned | Evans syndrome | Low-flow oxygen support, steroids, hydroxychloroquine (HCQ), azithromycine, full-dose LMWH, and empirical antibiotic therapy for superimposed bacterial infection. | The patient rapidly recovered from pneumonia but experienced two complications: paroxysmal atrial fibrillation treated with amiodarone, and wAIHA relapse that required IvIg and full-dose steroid (prednisone 1 mg/kg/day for 3 weeks followed by slow tapering, still ongoing). |
Georgy et al. [18] | July 2020 | India | A 33-year-old man | Presented to the emergency department with a 3-week history of gum bleeding, black tarry stools, and reddish spots on the skin, no fever, cough, or dyspnea, petechial lesions over the chest, legs, and oral mucosa, Within a few hours of admission, the patient complained of sudden-onset headache and developed a generalized tonic–clonic seizure. The patient’s sensorium worsened rapidly with anisocoria, | 3 weeks | Evans syndrome | He was shifted to the intensive care unit, he was treated with pulse dexamethasone 40 mg daily with platelet transfusions (intravenous immunoglobulin [IVIG] was not feasible),he had not received anticoagulation | Despite the above measures, there was no improvement in the patient’s platelet counts nor sensorium, and he died on the third day of admission died |
Current study | May 3, 2021 | Egypt | A 54-year-old male | Fever, arthralgia, myalgia, fatigue, and dark color of urine, pallor, jaundice, and then patient develop dyspnea, cough, and progressive fatigue Yellow discoloration of eyes, tachycardia, tachypnea, O2 sat: 80%. | Hematologic manifestations were the presenting symptoms from the start | Evans syndrome | Packed red blood cells, Favipiravir (200 mg) tab, Ivermectin (6 mg) tab, Dexamethasone 8 mg IV, cefatriaxone 1 g IV, moxiflox 400 mg, enoxaparin (clexan) 60 mg SC twice, oxygen using face mask, oral hypoglycemic (amaryl tab 3 mg plus metformin tab 750, Vitamin C 500 mg, along with other symptomatic medicine. | Recovered |