Evans Syndrome and COVID-19 Infection or Vaccination: A Systematic Review of Case Reports
Notice bibliographique
Résumé
Evans syndrome (ES) is an autoimmune disorder of unknown etiology characterized by autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). In this systematic review, we analyzed the reported cases of ES secondary to coronavirus disease 2019 (COVID-19) infection or COVID-19 vaccination. We examined their clinical presentation, temporality between events, diagnostics tests, and treatment regimens. Our search in four databases from December 2019 to September 2023 yielded 16 case reports that met eligibility criteria for inclusion. COVID-19 and ES symptoms were defined to assess the timeline between infection/vaccination and ES onset. Finally, treatment efficacy was categorized as complete, partial, or no response based on standard hematological criteria. Eleven cases of ES were associated with COVID-19 infection, and five cases of ES were associated with COVID-19 vaccination. All 16 cases presented with anemia, thrombocytopenia, and a positive Coombs test. Four of the five patients from the vaccination subset were found to have an additional autoimmune disease as a comorbidity on presentation. For cases of ES secondary to COVID-19 infection, six patients had concomitant symptoms of COVID-19 and ES on presentation, and four patients had ES symptoms occurring from 5 days to 3 weeks following COVID-19 infection. The remaining case presented a patient with a 3-week history of ES symptoms before a positive COVID-19 test and further ES workup on admission. For the five cases of ES post-COVID-19 vaccination, all five patients presented with ES with a mean presentation time of 9 days following vaccination. Regarding treatment, intravenous immunoglobulin (IVIG) emerged as the primary regimen, administered in 13 out of the 16 cases. Among the infection-related cases, the most frequent treatment outcome was a partial response in both AIHA and ITP, observed in five of the 11 patients. In the vaccination-related cases, a partial response for AIHA and a complete response for ITP were noted in three of the five patients. Overall, while the evidence points to a temporal association especially between COVID-19 vaccination and the onset of ES, larger studies are necessary to strengthen these findings. In terms of management, early initiation of corticosteroids and IVIG appears effective as first-line therapies; however, standardized treatment protocols are needed to help reduce complications associated with COVID-19-related ES.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,006 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».