Abstract
BackgroundIn this report, we describe a very challenging case of a patient with secondary Evans syndrome caused by severe coronavirus disease 2019 infection in a pregnant full-term woman.Case presentationA 29-year-old full-term pregnant Indonesian woman presented with gross hematuria, dry cough, fever, dyspnea, nausea, anosmia, and fatigue 5 days after confirmation of coronavirus disease 2019 infection. Laboratory examinations showed very severe thrombocytopenia, increased indirect bilirubin, and a positive direct Coombs’ test. From peripheral blood, there was an increased number of spherocytes, which indicated an autoimmune hemolytic process. Antinuclear antibody and anti-double-stranded DNA test results were negative, and her virology serological markers are also negative for human immunodeficiency virus, cytomegalovirus, and hepatitis B and C. Despite aggressive treatment with platelet transfusion, high-dose steroid, and thrombopoietin receptor agonists, the platelet count did not recover, and a speculative cesarean delivery had to be done with a very low platelet count.
Highlights
BackgroundCoronavirus disease 2019 (COVID-19) has been a devastating pandemic all across the world since late 2019
In this report, we describe a very challenging case of a patient with secondary Evans syndrome caused by severe coronavirus disease 2019 infection in a pregnant full-term woman.Case presentation: A 29-year-old full-term pregnant Indonesian woman presented with gross hematuria, dry cough, fever, dyspnea, nausea, anosmia, and fatigue 5 days after confirmation of coronavirus disease 2019 infection
We report a challenging case of a full-term pregnant Indonesian woman with severe COVID-19 complicated by secondary Evans syndrome (ES) with a successful outcome
Summary
Coronavirus disease 2019 (COVID-19) has been a devastating pandemic all across the world since late 2019. Case report A 29-year-old Indonesian woman was admitted to Dr Kariadi General Hospital with confirmed COVID-19 for 5 days She was gravida 2 para 1 abortus 0 (G2P1A0), pregnant 39 weeks, and presented with gross hematuria, dry cough, fever, dyspnea, nausea, anosmia, and fatigue. For the remaining days of her hospitalization, the patient was stable, and she was discharged on the 19th day with a platelet count of 45 × 109/L (Fig. 3) She received transfusion of a total of 2 units of platelet concentrate, 16 units of platelet, 5 units of leukodepleted packed red cells, 4 units of fresh frozen plasma, and 2 units of convalescent plasma. After 2 months of COVID-19 seroconversion, she was in a healthy condition, her hemoglobin and platelet levels returned to normal range, and all the medications were ceased She was diagnosed with secondary Evans syndrome
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