RESUMO
Background: SARS-CoV-2 disease (CoViD-19) is an important pandemic respiratory disease that emerged in China on December 2019 and quickly spread around the world. Many studies on SARSCoV- 2 infection demonstrate its association with an increased incidence of coagulopathy. In this case-report we describe a serious thrombocytopenia as an early manifestation of CoViD-19. Description of the case: A 59-year-old male with moderate dyspnea and rare petechiae spread to the trunk arrived at the DEA. He reported infection with SARS-CoV-2 from a week with the appearance of petechiae 24 hours before the discovery of positivity. He also reported COPD history and hypertension. At the entrance the patient was lucid, oriented and cooperative. The B.P. was 110/75 with sinus rhythm with pulse of 110 bpm, apyretic, SpO2 85% in A.A. To DEA showed examinations: thrombocytopenia (8,000), leukocytosis (15,560), D-Dimer 11727, VES 74, PCR 10.53, ferritin 1592, LDH 365. The EGA (Reservoir 90%) detected pO2 70.0 mmHg, pCO2 36.5 mmHg, pH7.44, SpO2 94% and P/F 78. The X-ray chest showed multiple thickening at the lower lobar seat bilaterally and moderately spread interstitial thickening. He was admitted to the CPAP cycle (FiO2 90% PEEP 7.5 cm H2O) and therapy based on dexamethasone, fluid therapy, cholecalciferol, antibiotics and multiple platelet transfusions. After 12 days the patient died. Conclusions: In many CoViD-19 studies the incidence of thrombocytopenia is about 36%. The peculiarity of this case-report is given by the serious thrombocytopenia as an initial manifestation in the absence of clinical bleeding.