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Revista de salud publica del Paraguay

On-line version ISSN 2307-3349

Abstract

MONTIEL, Dora Elizabeth et al. Thrombotic thrombocytopenic purpura associated with COVID-19. Rev. salud publica Parag. [online]. 2021, vol.11, n.1, pp.117-120. ISSN 2307-3349.  https://doi.org/10.18004/rspp.2021.junio.117.

Introduction:

Thrombotic thrombocytopenic purpura is a rare pathology, it has been associated with infection by the SARS-CoV-2 virus.

Clinical case:

27-year-old woman, consultation for 12 days with cough, asthenia, headache, muscle pain, loss of smell and taste. Nasopharyngeal swab is performed and returns positive for SARS-CoV-2. Receive outpatient treatment. 48 hours before admission, she presented paresthesia in the right hand that ascends to the right upper limb, with decreased muscle strength in the right hemibody, deviation of the labial commissure to the opposite side, recovery of muscle strength 40 minutes later, she is brought to the Hospital National. Physical Exam: HR 80 per minute, RR 20 per minute, BP 120-80 mmHg, temperature 36.2 °, pale conjunctiva. Nervous system exam: normal, rest of the physical exam without valuable data. Laboratory tests: Red blood cells 2.45 per 109, hemoglobin (Hb 7.6 g / dl), hematocrit (Ht 22%), platelets 34,000 per mm3. Reticulocytes 12.6% (0.5-2%), urea 30 mg / dl, creatinine 0.76 mg / dl, total bilirubin 3.05 mg / dl direct bilirubin 0.79 mg / dl, indirect bilirubin 2.26 mg / dl, haptoglobin 2mg / dl, GOT 45 U / L, GPT 27 U / L, LDH 1553 Ul, CRP 2.4 mg / dl. Serology: toxoplasmosis. IgG 924.2. IgM 0.2 (negative), rubella: IgG 283.30, IgM 0.2 (negative), cytomegalovirus IgG 165.2 IgM 0.5 negative. Herpes HSV1 and 2 positive IgG negative IgM, C3 154, C4 25 mg / dl (10-40 mg / dl), negative direct Coombs test, ferritin 1380 ng / ml. Anti-nuclear antibody (ANA), anti-double-stranded DNA antibody (anti-DNA), negative. Peripheral blood smear: schistocytes (+++). Normal skull tomography. Chest tomography: bilateral mild bibasal interstitial infiltrate. The diagnosis of thrombotic thrombocytopenic purpura (TTP) was made, he received 100 mg of methylprednisolone, fresh plasma, red blood cells, he died 24 hours later during plasmapheresis of a bleeding in the central nervous system.

Discussion:

TTP is a serious pathology, it can occur in patients with COVID-19.

Keywords : COVID-19; Thrombotic thrombocytopenic purpura; SARS-CoV-2 virus.

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