Evan syndrome as initial presentation of COVID-19 infection

Abstract Background Evans’ syndrome (ES) is a rare and chronic autoimmune disease characterized by the concomitant or sequential association of auto-immune hemolytic anemia (AIHA) with immune thrombocytopenia (ITP), less frequently neutropenia positive direct anti-human globulin test. ES represents up to 7% AIHA around 2% ITP. Studies have found that coronavirus 2019 (COVID-19) may be associated various hematological complications, i.e., coagulopathies; however, finding Evans novel case. Case report A 54-year-old diabetic man complaining fever (high grade), arthralgia myalgia, fatigue, dark color urine. He was admitted isolation sector at Sohag General Hospital on day 6 because cough, dyspnea, progressive admission, he tachypneic, tachycardiac, jaundiced, febrile (38 °C), hypoxemic (O2 saturations room air 80%). Laboratory studies showed hemoglobin (Hb) 5.43 g/dL, high reticulocyte (12.5%), ↓ed platelet count (54 × 10 3 /μl), hyperbilirubinemia elevated C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase. Markers diseases screening for malignant were negative. HRCT chest bilateral small-sized peripheral ground glass opacities in both lungs, reverse transcriptase-polymerase chain reaction (RT-PCR) SARS-CoV-2 RNA nasopharyngeal swab. Direct Coombs test immunoglobulin (IgG) C3d. secondary COVID-19 diagnosed treatment packed red cell (PRC) transfusions, favipiravir, dexamethasone, prednisone, ceftriaxone, enoxaparin, oral hypoglycemic, oxygen using face mask, then Hb value increased 10.3 g/dL discharged home without any complications. Conclusion There are few reports patients concurrent syndrome. So, infection should considered patient presenting new-onset unclear etiology.