Supplementary Material for: An Early Unexpected Immune Thrombotic Thrombocytopenic Purpura Relapse Associated with SARS-CoV-2 Infection: A Case Report and Literature Review

SARS-CoV-2 has been reported as a possible triggering factor for the development of several autoimmune diseases and inflammatory dysregulation. Here, we present a case report of a woman with a history of systemic lupus erythematosus and antiphospholipid syndrome, presenting with concurrent COVID-19 infection and immune thrombotic thrombocytopenic purpura (TTP). The patient was treated with plasma exchange, steroids, and caplacizumab with initial good response to therapy. The course of both TTP and COVID-19 disease was mild. However, after ADAMTS-13 activity was normalized, the patient experienced an early unexpected TTP relapse manifested by intravascular hemolysis with stable platelet counts requiring further treatment. Only 3 cases of COVID-19 associated TTP were reported in the literature thus far. We summarize the literature and suggest that COVID-19 could act as a trigger for TTP, with good outcomes if recognized and treated early.已有研究表明，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可能是多种自身免疫性疾病及炎症失调的潜在诱发因素。本文报道1例既往罹患系统性红斑狼疮（systemic lupus erythematosus）与抗磷脂综合征（antiphospholipid syndrome）的女性患者，该患者同时感染新型冠状病毒并并发免疫性血栓性血小板减少性紫癜（immune thrombotic thrombocytopenic purpura，TTP）。患者接受血浆置换、糖皮质激素及卡普拉珠单抗（caplacizumab）治疗，初期治疗应答良好。此次TTP与新型冠状病毒感染的病程均较为轻微。然而，在ADAMTS-13活性恢复正常后，患者出现了意料之外的早期TTP复发，表现为血管内溶血且血小板计数维持稳定，需进一步接受治疗。截至目前，文献中仅报道过3例新型冠状病毒相关TTP病例。本文总结现有相关文献，并提出观点：SARS-CoV-2可作为TTP的诱发因素，若早期识别并及时予以治疗，可获得良好预后。