Immune Thrombocytopenic Purpura – Different Presentations in Two COVID-19 Patients

Immune thrombocytopenic purpura (ITP) is a rare acquired autoimmune disease, resulting from platelet destruction and impaired platelet production. It has been described as associated with either genetic or environmental risk factors, such as viral infections, and in a few cases has been reported to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although steroid treatment is the most widely used first-line treatment of ITP, in the early days of coronavirus disease 2019 (COVID-19) it was controversial, but it has since become approved in treatment for COVID-19. The authors report two different cases of COVID-19-associated ITP, with special emphasis on the timing of presentation, severity, and treatment decisions. Remarkably, one of the patients who suffered severe thrombocytopenia was safely treated with corticosteroids in the late phase of COVID-19 infection.