Author Information
An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 45-year-old man exhibited lack of efficacy following treatment with immune-globulin and rituximab for thrombocytopenia.
The previously healthy man was admitted in the emergency department with fever, dry cough, myalgia, malaise, arthralgia and swelling of the legs. Following admission, he was diagnosed with COVID-19. He then transferred to the isolation area for COVID-19 patients; where he received off label treatment with IV dexamethasone 6 mg/day and IV ceftriaxone 1g twice daily, furosemide 20 mg IV twice daily. He also received symptomatic treatment with paracetamol and furosemide. Based on the clinical and laboratory findings, he was diagnosed with systemic lupus erythematosus (SLE), possibly triggered by COVID-19 infection. With the initial treatment, he showed improvement although he had persistent severe thrombocytopenia and abnormal liver function tests. Following treatment with pulse methylprednisolone and chloroquine, kidney and liver functions significantly improved. For persistent severe thrombocytopenia, he received IV immune-globulin [immunoglobulin] 2mg/kg for 4 days and rituximab 600mg (3 doses). Despite these, thrombocytopenia persisted and became refractory. He then underwent splenectomy. This raised his platelet count. He then discharged on prednisone and chloroquine.
Reference
- Gracia-Ramos AE, et al. Can the SARS-CoV-2 infection trigger systemic lupus erythematosus? A case-based review. Rheumatology International 41: 799-809, No. 4, Apr 2021. Available from: URL: 10.1007/s00296-021-04794-7 [DOI] [PMC free article] [PubMed]