A rare case of vaccine-induced immune thrombosis and thrombocytopenia and approach to management

Abstract

Background: The use of the COVID-19 vaccines Vaxzevria from AstraZeneca and Covishield from Janssen has been associated with sporadic reports of thrombosis with thrombocytopenia, a complication referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT) or vaccine-induced prothrombotic immune thrombocytopenia. It presents commonly as cerebral sinus venous thrombosis (CSVT), within 4–30 days of vaccination. Females under 55 years of age are considered to be especially at high risk. Mortality up to 50% has been reported in some countries. Identification of early warning signs and symptoms with prompt medical intervention is crucial. Case Description: We report here a case of VITT in a young female who presented 11 days after receiving the first dose of the Covishield vaccine, with severe headache and hemiparesis. She was diagnosed with CSVT with a large intraparenchymal bleed, requiring decompressive craniectomy and extended period on mechanical ventilation. Conclusion: The patient was successfully treated with intravenous immunoglobulin and discharged after 19 days in ICU. Although she was left with long-term neurological deficits, an early presentation and a multidisciplinary approach to management contributed toward a relatively short stay in hospital and avoided mortality.

Ad26.COV2.S Vaccine-Induced Thrombocytopenia Leading to Dural Sinus Thrombosis and Intracranial Hemorrhage Requiring Hemicraniectomy: A Case Report and Systematic Review

“…However, the two excluded studies from this search are worth mentioning as they describe cases of CVST after another adenovirus vaccine-ChAdOx1-and both required decompressive craniotomies [19,20]. Both cases are of young patients (27-year-old male and 32-year-old female) who presented with headaches to the ED within two weeks of receiving the ChAdOx1 vaccine.…”

A Rare Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia in a Young Patient

“…Recently in late February 2021, a very rare prothrombotic disorder in combination with thrombocytopenia has been reported following vaccination with the adenovirus vector-based vaccines ChAdOx1 nCoV-19 from AstraZeneca/Oxford (marketed as Vaxzevria and Covishield) and recently Ad.26.COV2.S from Janssen (Johnson & Johnson) [ 1 ]. This novel disorder, known as vaccine-induced immune thrombotic thrombocytopenia (VITT) is associated with high titers of immunoglobulin G class antibodies directed against the cationic platelet chemokine, platelet factor 4 (PF4; CXCL4) [ 2 ].…”

“…VITT, with its high mortality and morbidity, should be suspected when a patient develops symptoms such as severe headache, blurred vision, vomiting, altered sensorium, focal neurological deficits, abdominal pain, leg pain, and/or swelling or dyspnoea, four to thirty days after vaccination [ 1 , 4 ]. Awareness of VITT, identification of early warning signs and symptoms, with proper management is crucial [ 4 ].…”