ANTIPHOSPHOLIPID-LIKE SYNDROME INDUCED BY COVID19: A CASE REPORT STUDY
Abstract
Many patients with severe COVID-19 present with coagulation abnormalities associated with severe infections, such as disseminated intravascular coagulation or trombotic mycroangiopathy. That’s why is important to pay attention to the differential diagnoses of COVID-19 and other diseases following thrombotic events. Antiphospholipid syndrome is an autoimmune disorder characterized by thrombosis. The diagnosis criteria for antiphospholipid syndrome are based on the detection of abnormal levels of at least one of the most common antiphospholipid antibodies . In this study, we discuss the relationship between COVID-19, antiphospholipid syndrome and antiphospholipid syndrome -like phenomenon, and thrombosis that may occur. We present a 60-year-old woman hospitalized for COVID-19 and pneumonia with a moderately severe clinical picture. During the hospitalization under anticoagulant therapy, she developed coagulation disorders with prolonged active partial thromboplastin time, positive lupus anticoagulant and positive beta-2glycoprotein. The coagulation disorder is in addition to antiphospholipid syndrome, which is associated with the possibility of bleeding in the patient. Elevated levels of the isotypes of antiphospholipid antibodies in COVId-19 patients create antiphospholipid syndrome-like condition. Considering the high rate of mortality due to coagulation abnormalities and thrombosis among COVID-19 patients, it is important to pay attention to the differential diagnoses of COVID-19 and other diseases following thrombotic events, as well as their implication on the therapeutic approach to patients. Current data recommend the use of prophylactic anticoagulation with low molecular weight heparin in hospitalized patients with COVID-19 regardless of the severity of the clinical picture.
Key words: COVID-19, antiphospholipid syndrome, antiphospholipid antibodies, coagulation disorders, thrombosis, lupus anticoagulant, anti-beta 2 glycoprotein I (anti-b2GPI), immune disorders, antimalarials, anticoagulant therapy, plateled agonists
References
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2. da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, Farias de Oliveira T, Campos Alcântara R, Monteiro Arnozo G, Rodrigues da Silva Filho E, Galdino Dos Santos AG, Oliveira da Cunha EJ, Salgueiro de Aquino SH, Freire de Souza CD. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr. 2021 Apr;133(7-8):377-382. doi: 10.1007/s00508-020-01760-4. Epub 2020 Nov 26. PMID: 33242148; PMCID: PMC7689634.
3. Center for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). https://www.cdc.gov/ coronavirus/2019-ncov/symptoms-testing/symptoms. html. Accessed 27May 2020
4. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA, West TE, Luks A, Gerbino A, Dale CR, Goldman JD, O'Mahony S, Mikacenic C. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020 May 21;382(21):2012-2022. doi: 10.1056/NEJMoa2004500. Epub 2020 Mar 30. PMID: 32227758; PMCID: PMC7143164.
5. Datta PK, Liu F, Fischer T, Rappaport J, Qin X. SARS-CoV-2 pandemic and research gaps: Understanding SARS-CoV-2 interaction with the ACE2 receptor and implications for therapy. Theranostics. 2020 Jun 12;10(16):7448-7464. doi: 10.7150/thno.48076. PMID: 32642005; PMCID: PMC7330865.
6. Levi M, Scully M. How I treat disseminated intravascular coagulation. Blood. 2018 Feb 22;131(8):845-854. doi: 10.1182/blood-2017-10-804096. Epub 2017 Dec 18. PMID: 29255070.
7. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020 Jun;7(6):e438-e440. doi: 10.1016/S2352-3026(20)30145-9. Epub 2020 May 11. PMID: 32407672; PMCID: PMC7213964.
8. Peng K, Li X, Yang D, Chan SCW, Zhou J, Wan EYF, Chui CSL, Lai FTT, Wong CKH, Chan EWY, Leung WK, Lau CS, Wong ICK. Risk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study. EClinicalMedicine. 2023 Aug 16;63:102154. doi: 10.1016/j.eclinm.2023.102154. PMID: 37637754; PMCID: PMC10458663
9. El Hasbani G, Jawad A, Uthman I. Axial and peripheral spondyloarthritis triggered by sars-cov-2 infection: a report of two cases. Reumatismo. 2021 Apr 19;73(1):59-63. doi: 10.4081/reumatismo.2021.1374. PMID: 33874649.
10. Derksen VFAM, Kissel T, Lamers-Karnebeek FBG, van der Bijl AE, Venhuizen AC, Huizinga TWJ, Toes REM, Roukens AHE, van der Woude D. Onset of rheumatoid arthritis after COVID-19: coincidence or connected? Ann Rheum Dis. 2021 Aug;80(8):1096-1098. doi: 10.1136/annrheumdis-2021-219859. Epub 2021 Mar 1. PMID: 33648960.
11. Olson N, Eckhardt D, Delano A. New-Onset Bullous Pemphigoid in a COVID-19 Patient. Case Rep Dermatol Med. 2021 Jun 7;2021:5575111. doi: 10.1155/2021/5575111. PMID: 34211788; PMCID: PMC8187076.
12. Deruelle E, Ben Hadj Salem O, Sep Hieng S, Pichereau C, Outin H, Jamme M. Immune thrombocytopenia in a patient with COVID-19. Int J Hematol. 2020 Dec;112(6):883-888. doi: 10.1007/s12185-020-02943-5. Epub 2020 Jul 16. PMID: 32677007; PMCID: PMC7365304.
13. Palao M, Fernández-DÃaz E, Gracia-Gil J, Romero-Sánchez CM, DÃaz-Maroto I, Segura T. Multiple sclerosis following SARS-CoV-2 infection. Mult Scler Relat Disord. 2020 Oct;45:102377. doi: 10.1016/j.msard.2020.102377. Epub 2020 Jul 7. PMID: 32698095; PMCID: PMC7340057.
14. Reiff DD, Meyer CG, Marlin B, Mannion ML. New onset ANCA-associated vasculitis in an adolescent during an acute COVID-19 infection: a case report. BMC Pediatr. 2021 Aug 5;21(1):333. doi: 10.1186/s12887-021-02812-y. PMID: 34353302; PMCID: PMC8338201.
15. Agarwala SR, Vijayvargiya M, Pandey P. Avascular necrosis as a part of 'long COVID-19'. BMJ Case Rep. 2021 Jul 2;14(7):e242101. doi: 10.1136/bcr-2021-242101. PMID: 34215639; PMCID: PMC8256728
16. Bahramnezhad F, Ghorbani B, Ghaedrahamt M, Jamaati H. Coronavirus-disease-2019-induced antiphospholipid-like syndrome: a case report. J Med Case Rep. 2021 Jul 29;15(1):408. doi: 10.1186/s13256-021-02966-4. PMID: 34321077; PMCID: PMC8318629.
17. Serrano M, Espinosa G, Cervera R, Serrano A. COVID-19 coagulopathy and antiphospholipid syndrome. Revista Colombiana de ReumatologÃa. 2022 Jun;29:S25–34. doi: 10.1016/j.rcreu.2021.02.013. Epub 2021 Aug 27. PMCID: PMC8390358.
18. Tung ML, Tan B, Cherian R, Chandra B. Anti-phospholipid syndrome and COVID-19 thrombosis: connecting the dots. Rheumatol Adv Pract. 2021 Feb 4;5(1):rkaa081. doi: 10.1093/rap/rkaa081. PMID: 33615129; PMCID: PMC7882149.
19. Bustamante JG, Goyal A, Singhal M. Antiphospholipid Syndrome. 2023 Feb 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28613698.
20. Chidharla A, Syed SB, Chatterjee T, Tarantino MD. A Case Report of COVID-Associated Catastrophic Antiphospholipid Syndrome Successfully Treated with Eculizumab. J Blood Med. 2021 Oct 30;12:929-933. doi: 10.2147/JBM.S324873. PMID: 34744467; PMCID: PMC8566005.
21. Del Ross T, Ruffatti A, Cuffaro S, Tonello M, Calligaro A, Favaro M, Facchinetti M, Hoxha A, Punzi L. The clinical relevance of the IgM isotype of antiphospholipid antibodies in the vascular antiphospholipid syndrome. Thromb Res. 2015 Nov;136(5):883-6. doi: 10.1016/j.thromres.2015.08.019. Epub 2015 Sep 5. PMID: 26410418.
22. Kravvariti E, Koutsogianni A, Samoli E, Sfikakis PP, Tektonidou MG. The effect of hydroxychloroquine on thrombosis prevention and antiphospholipid antibody levels in primary antiphospholipid syndrome: A pilot open label randomized prospective study. Autoimmun Rev. 2020 Apr;19(4):102491. doi: 10.1016/j.autrev.2020.102491. Epub 2020 Feb 19. PMID: 32084592
23. Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, Thursz M, Manousou P, Corbett R, Goldin R, Al-Sarraj S, Abdolrasouli A, Swann OC, Baillon L, Penn R, Barclay WS, Viola P, Osborn M. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe. 2020 Oct;1(6):e245-e253. doi: 10.1016/S2666-5247(20)30115-4. Epub 2020 Aug 20. PMID: 32844161; PMCID: PMC7440861.
24. Jovanoski M, Boshev M, Marinkovikj Petrusevska S, Srceva Jovanovski M, Georgiev A, Damjanovska Lj. Pulmonary embolism in a patient with COVID-19 pneumonia despite satisfying anticoagulation status Macedonian Journal of Anaes thesia, Dec 2022,3(6):60-69;
25. Germain R.N. The cellular determinants of adaptive immunity. N Engl J Med. 2019;381:1083–1085. doi: 10.1056/NEJMcibr1909387.
26. Berry R, Watson GM, Jonjic S, Degli-Esposti MA, Rossjohn J. Modulation of innate and adaptive immunity by cytomegaloviruses. Nat Rev Immunol. 2020 Feb;20(2):113-127. doi: 10.1038/s41577-019-0225-5. Epub 2019 Oct 30. PMID: 31666730.
27. Norbury CC, Malide D, Gibbs JS, Bennink JR, Yewdell JW. Visualizing priming of virus-specific CD8+ T cells by infected dendritic cells in vivo. Nat Immunol. 2002 Mar;3(3):265-71. doi: 10.1038/ni762. Epub 2002 Feb 4. PMID: 11828323
28. James JA, Robertson JM. Lupus and Epstein-Barr. Curr Opin Rheumatol. 2012 Jul;24(4):383-8. doi: 10.1097/BOR.0b013e3283535801. PMID: 22504579; PMCID: PMC3562348.
29. Delgado-Roche L, Mesta F. Oxidative Stress as Key Player in Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) Infection. Arch Med Res. 2020 Jul;51(5):384-387. doi: 10.1016/j.arcmed.2020.04.019. Epub 2020 Apr 30. PMID: 32402576; PMCID: PMC7190501.
30. Xiao M, Zhang Y, Zhang S, Qin X, Xia P, Cao W, Jiang W, Chen H, Ding X, Zhao H, Zhang H, Wang C, Zhao J, Sun X, Tian R, Wu W, Wu D, Ma J, Chen Y, Zhang D, Xie J, Yan X, Zhou X, Liu Z, Wang J, Du B, Qin Y, Gao P, Lu M, Hou X, Wu X, Zhu H, Xu Y, Zhang W, Li T, Zhang F, Zhao Y, Li Y, Zhang S. Antiphospholipid Antibodies in Critically Ill Patients With COVID-19. Arthritis Rheumatol. 2020 Dec;72(12):1998-2004. doi: 10.1002/art.41425. Epub 2020 Oct 7. PMID: 32602200; PMCID: PMC7361932.
31. Hernández-Pérez JM, MartÃn-González E, Pino-Yanes M. Strengths and weaknesses of the diagnostic tests for SARS-CoV-2 infection. Med Clin (Engl Ed). 2020 Nov 27;155(10):464-465. doi: 10.1016/j.medcle.2020.05.025. Epub 2020 Oct 30. PMID: 33521299; PMCID: PMC7836751.
32. Newall F. Anti-factor Xa (anti-Xa) assay. Methods Mol Biol. 2013;992:265-72. doi: 10.1007/978-1-62703-339-8_19. PMID: 23546719
33. Ramasamy I.Inherited bleeding disorders: disorders of platelet adhesion and aggregation, Critical Rev in Oncol./Hematol, 2004,49( 1),1-35,ISSN 1040-8428,https://doi.org/10.1016/S1040-8428(03)00117-3.
34. Stelzer M, Henes J, Saur S. The Role of Antiphospholipid Antibodies in COVID-19. Curr Rheumatol Rep. 2021 Jul 14;23(9):72. doi: 10.1007/s11926-021-01041-7. PMID: 34259944; PMCID: PMC8278370.
35. McDonnell T, Wincup C, Buchholz I, Pericleous C, Giles I, Ripoll V, Cohen H, Delcea M, Rahman A. The role of beta-2-glycoprotein I in health and disease associating structure with function: More than just APS. Blood Rev. 2020 Jan;39:100610. doi: 10.1016/j.blre.2019.100610. Epub 2019 Aug 16. PMID: 31471128; PMCID: PMC7014586.
36. Haładyj E, Sikora M, Felis-Giemza A, Olesińska M. Antimalarials - are they effective and safe in rheumatic diseases? Reumatologia. 2018;56(3):164-173. doi: 10.5114/reum.2018.76904. Epub 2018 Jun 30. PMID: 30042604; PMCID: PMC6052376.
.
Published
2024-05-01
How to Cite
PETRUSEVSKA MARINKOVIC, Sanja; ANASTASOVSKI, Ankcia; TODOROVSKA, Lidija.
ANTIPHOSPHOLIPID-LIKE SYNDROME INDUCED BY COVID19: A CASE REPORT STUDY.
Journal of Morphological Sciences, [S.l.], v. 7, n. 1, p. 171-181, may 2024.
ISSN 2545-4706.
Available at: <https://jms.mk/jms/article/view/vol7no1-22>. Date accessed: 16 sep. 2024.
Issue
Section
Case Report
