Refractory thrombocytopenia in a severe COVID-19 patient

Severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2) infection has spread worldwide. The most of patients presents fever, dyspnea and cough as a typical viral infection, others show peculiar clinical and laboratory signs, such as anosmia, ageusia and thrombocytopenia. We here describe a severe coronavirus disease 2019 patient (76-year old, male) that developed an immune thrombocytopenia and acquired pseudo-thrombocytopenia that were refractory to immunomodulators even after resolution of respiratory failure. The patient developed thrombocytopenia (platelets 88,000/mm³) that got worse the following day (14,000/mm³). We started 1 mg/kg of methylprednisolone i.v. daily. Platelet count increased up to 209,000/mm³, in sodium citrate, but remained about 14,000/mm³ in EDTA 10 days after the beginning of methylprednisolone. The patient showed great improvement in respiratory parameters and radiological finding. About one week after he developed a thrombocytopenia up to 70,000/mm³. We did not modify the steroids dosage. Platelet count slowly began to increase and in about 10 days returned to normal values.