{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T18:57:18Z","timestamp":1757703438533,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,10,30]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>Immune thrombocytopenic purpura (ITP) is an uncommon condition resulting from the autoimmune destruction of platelets. A man in his mid-30s, who had received three doses of the SARS-CoV-2 vaccine a year prior, was diagnosed with ITP 3\u2009weeks after contracting COVID-19. Mechanisms of SARS-CoV-2 induced thrombocytopenia may include bone marrow depletion, coagulation consumption, mutations resulting in cytokine release or molecular mimicry leading to autoimmunity. Initial treatment involved glucocorticoids, but the disease course progressed into glucocorticoid-resistant ITP. Subsequently, the patient was diagnosed with ITP refractory to intravenous immunoglobulin, thrombopoietin receptor agonist, rituximab, cyclophosphamide, inhibitors of BTK and SYK, and other pharmacological agents. Despite exhaustive medical interventions, bleeding diathesis and platelet counts worsened, so the patient underwent a splenectomy resulting in the resolution of the thrombocytopenia.<\/jats:p>","DOI":"10.1136\/bcr-2024-259754","type":"journal-article","created":{"date-parts":[[2024,11,24]],"date-time":"2024-11-24T13:05:23Z","timestamp":1732453523000},"page":"e259754","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Refractory immune thrombocytopenic purpura (ITP) secondary to prior COVID-19 infection requiring a splenectomy"],"prefix":"10.1136","volume":"17","author":[{"given":"Moki","family":"Hein","sequence":"first","affiliation":[{"name":"College of Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vielka","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6018-5535","authenticated-orcid":false,"given":"Jacqueline C","family":"Barrientos","sequence":"additional","affiliation":[{"name":"Haematology and Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Hochwald","sequence":"additional","affiliation":[{"name":"Surgical Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,24]]},"reference":[{"key":"2025082709342606000_17.11.e259754.1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/20009666.2019.1565884","article-title":"Immune thrombocytopenic purpura","volume":"9","author":"Zainal","year":"2019","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2025082709342606000_17.11.e259754.2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s12254-018-0428-7","article-title":"Current and evolving treatment strategies in adult immune thrombocytopenia","volume":"11","author":"Bohn","year":"2018","journal-title":"memo"},{"key":"2025082709342606000_17.11.e259754.3","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1007\/s42399-020-00521-8","article-title":"Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review","volume":"2","author":"Bhattacharjee","year":"2020","journal-title":"SN Compr Clin Med"},{"key":"2025082709342606000_17.11.e259754.4","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-250153","article-title":"Severe case of refractory immune thrombocytopenic purpura requiring splenectomy after the COVID-19 vaccine","volume":"15","author":"Koilpillai","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2025082709342606000_17.11.e259754.5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12959-022-00404-z","article-title":"Very severe immune thrombocytopenia following SARS-CoV-2 vaccination requiring splenectomy: a case report","volume":"20","author":"Weiner","year":"2022","journal-title":"Thromb J"},{"key":"2025082709342606000_17.11.e259754.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2022-249477","article-title":"Immune thrombocytopaenic purpura following the second dose of Pfizer COVID-19 vaccine","volume":"15","author":"Latef","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2025082709342606000_17.11.e259754.7","unstructured":"American Society of Hematology . Vaccine-induced immune thrombotic thrombocytopenia (vitt). Hematology.org; 2022. Available: https:\/\/www.hematology.org\/covid-19\/vaccine-induced-immune-thrombotic-thrombocytopenia [Accessed 7 Sep 2024]."},{"key":"2025082709342606000_17.11.e259754.8","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1111\/bjh.16885","article-title":"Delayed-phase thrombocytopenia in patients with coronavirus disease 2019 (COVID-19)","volume":"190","author":"Chen","year":"2020","journal-title":"Br J Haematol"},{"key":"2025082709342606000_17.11.e259754.9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/jmv.26138","article-title":"COVID-19 presenting with immune thrombocytopenia: A case report and review of the literature","volume":"93","author":"Murt","year":"2021","journal-title":"J Med Virol"},{"key":"2025082709342606000_17.11.e259754.10","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000966"},{"key":"2025082709342606000_17.11.e259754.11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-12-309153"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-259754","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:34:35Z","timestamp":1756312475000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-259754"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":11,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,24]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bcr-2024-259754"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-259754","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}