Azd-1222

Abstract

Acute gastroenteritis with pancytopenia, transaminitis and psychosis: case reportAn 18-year-old woman developed acute gastroenteritis with pancytopenia, transaminitis and psychosis following vaccination with AZD-1222 [dosage and route not stated; not all durations of treatment to reaction onsets stated].The woman with no psychotic history was brought to the emergency department by family members for irrelevant talk and bizarre behavior. There was no history of substance use. After explosring her history, it was revealed that, she was well before receiving her first dose of AZD-1222 [Vaxzevria] vaccine. Within two to three hours of receiving vaccine, she developed high grade fever with chills, and multiple episodes of loose stools.The woman received unspecified antipyretics, which did not improve her symptoms. She then had dizziness and one episode of fall, after which she visited a local hospital, where she received treatment with unspecified IV fluids. Next day, her fever subsided, however, she started to remain anxious. She could not sleep at night, used to woke-up frequently, appeared fearful and would appear to be staring in between. She kept on pacing around and used to appear distressed. During the next 3 to 4 days, she started to remain irritable, talked irrelevantly, tried to run away from home, voiced delusions of persecution and reference, and had visual hallucinations of seeing Gods and demons. Because of these uncontrollable symptoms, she was brought to the emergency department. She was found to be negative for COVID-19 infection. However, she had pancytopenia and transaminitis, according to the investigational results. A diagnosis of AZD-1222 induced acute gastroenteritis with pancytopenia and transaminitis was considered. A consultation with psychiatrist was suggested for her psychotic symptoms. After psychiatric evaluation, differential diagnoses of organic psychosis versus acute and transient psychosis vs delirium were considered. She was started with olanzapine. Blood culture, urine examination including culture, cerebrospinal fluid examination, Wilson disease work-up, evaluation for systemic lupus erythematosus and workup for autoimmune encephalitis were all normal. EEG also showed normal results. However, brain MRI showed discrete tiny T2/FLAIR hyperintensities in deep white matter in bilateral fronto-parietal lobes. Due to absence of relevant symptoms, delirium was ruled out. After ruling out other causes, and relating a temporal association of symptoms with vaccine administration, a diagnosis of vaccine associated psychosis was considered. Because of continued symptoms and catatonia in the form of mutism, staring, rigidity and negativism, she was also started with lorazepam. The dose of olanzapine was also increased slowly. She showed significant improvement within 2 weeks, after which lorazepam was tapered off. She maintained well for three months with good adherence and regular follow-up. The dose of olanzapine was reduced further. She refused to take the next dose of the vaccine.