Other causes of thrombocytopenia were excluded (Table ?(Table1)1) and a post-COVID-19 ITP was diagnosed. infection in November 2020 (detected by PCR on 6/11/20, with positive IgG antibodies on 22/11/20 and negative PCR since 26/1//21). Two months later, in January 2021, he presented with epistaxis and melenic stools. The SARS-CoV-2 PCR was negative, but the platelet count was 6 109/L, refractory to platelet transfusions. Bone marrow studies were normal (Table ?(Table1).1). A folic acid deficiency was detected and treated without platelet improvement. Endoscopic tests were ruled out due to the patients baseline situation. Other causes of thrombocytopenia were excluded (Table ?(Table1)1) and a post-COVID-19 ITP was diagnosed. The patient received IVIg (1 g/kg/day for 2 days) achieving a quick platelet complete response. In February 2021, the patient was admitted again due to severe thrombocytopenia (6 109/L) and treated with intravenous IVIg and dexamethasone Monastrol 40 mg/day for 4 days, and achieving a second complete platelet response. In March 2021, the patient was readmitted with severe thrombocytopenia and self-limited upper gastrointestinal bleeding. Combined treatment with IVIg and eltrombopag 50 mg/day was started, Monastrol Monastrol without alteration of liver function test, and a third maintained Monastrol platelet complete response was observed. Most COVID-19-associated ITP patients have been detected during COVID-19 infection [1]. In those cases, the use of corticosteroids as first-line treatment is recommended, due to the risk of thrombosis related to thrombopoietin analogues. On the contrary, thrombopoietin analogues are considered first-line in COVID-19-negative ITP patients, due to the risk of immunosuppression associated with corticosteroids [6]. Post-COVID-19 infection ITP is a rarely described type of ITP, without treatment guidelines [1, 4]. Herein, we report two adult cases observed 4 and 8 weeks after a mild COVID-19 infection. Both patients presented with bleeding manifestations as well as anti-SARS-CoV-2 IgG antibodies and negative PCR tests at the time of ITP diagnosis. In previously reported cases, standard treatment with glucocorticoids and IVig has been effective in achieving a rapidly response [5]. Similarly, our patients had initial responses, but short-lived and followed by recurrent relapses that needed additional treatment strategies. A diagrammatic presentation of treatment offered to our post-COVID-19 ITP patients has been given in Fig. ?Fig.1.1. This atypical clinical course with bleeding signs and frequent relapses in post-COVID-19 ITP should be confirmed with further reports and points out the necessity of basic studies to ascertain the pathophysiology of Neurog1 post-COVID-19 ITP. Our case series show that clinicians should continue follow up of recovered COVID-19 patients so that long-term effects could be uncovered of this novel virus. Open in a separate window Fig. 1 Treatment offered to post-COVID-19 ITP patients. MTP, methylprednisolone (1 mg/kg/day for 7 days); RX, rituximab (375 mg/m2/week for 4 weeks); IVIg, unspecific immunoglobulins (1 g/kg/day i.v. for 2 days); DEX, dexamethasone (40 mg/day for 4 days); TP50, eltrombopag (50 mg/day daily); TP75, eltrombopag (75 mg/day every day); MMF, mycophenolate mofetil (1 g/12 h daily) Author Contribution The authors of the article meet the authorship criteria established by the International Committee of Medical Journal Editors. Availability of Data and Material Not applicable Code Availability Not applicable Declarations Ethics ApprovalNot applicable Consent to Monastrol ParticipateNot applicable Consent for PublicationAll authors give their consent for its publication. Conflict of InterestThe authors declare no competing interests. Footnotes This article is part of the Topical Collection on em Covid-19 /em Publishers Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations..
