Azd-1222

Abstract

Cerebral sinus vein thrombosis: 2 case reportsIn a case series, 2 women (20-year and 28-year-old) were described, who developed cerebral sinus vein thrombosis (CSVT) following the first dose of AZD-1222 [dosages and routes not stated].Patient A: A 20-year-old woman, who had received first dose of AZD-1222 vaccine injection [chAdOx1-S; manufactured by AstraZeneca], presented with an unspecified drug-refractory headache after 11 days. She had been receiving hormonal contraception gestagen/ethinylestradiol. Laboratory examination revealed slightly elevated D-dimers. MRI with axial and sagittal T1 with contrast (MP-RAGE) showed a CSVT, without any sign of cerebral ischaemic or haemorrhagic infarct. She reported that she had noted unilateral calf pain for already several weeks. Her ultrasound examination demonstrated subacute thrombophlebitis of the small right saphenous vein. Later, laboratory tests revealed a screening panel for vasculitis and collagenases as well as thrombophilia. She had a slightly elevated β2-glycoprotein-IgG titer. She was diagnosed with Hashimoto's thyroiditis with hypothyroidism. Eventually, a heterozygous MTHFR A1298C mutation was also confirmed. After 21 days, SARS-CoV-2 IgG blood titer was 650 AU/mL. Additionally, she had developed vaccine-specific cellular immunity. Her hormonal contraception was also stopped. Thereafter, she was treated with low-molecular-weight heparin and later replaced by phenprocoumon. After 1 week, she was discharged without any neurological symptoms.Patient B: A 28-year-old woman, who had received the first dose of AZD-1222 vaccine injection [chAdOx1-S; manufactured by AstraZeneca], presented with unspecified drug-refractory headache after 16 days. She had been receiving hormonal contraception i.e unspecified gestagen/ethinylestradiol. Laboratory examination revealed slightly elevated D-dimers. MRI with axial and sagittal T1 with contrast (MP-RAGE) showed a CSVT, without any sign of cerebral ischaemic or haemorrhagic infarct. She had a history of pulmonary embolism after patella surgery, which was followed by rivaroxaban treatment for 1 year. Later, homozygous MTHFR C677T mutation and a heterozygous plasminogen activator inhibitor-1 gene polymorphism was observed. After 21 days of vaccination, SARS-CoV-2 IgG blood titer was observed greater than 16,500 AU/mL. Additionally, she had developed vaccine-specific cellular immunity. Her hormonal contraceptive was stopped and low-molecular-weight heparin was initiated and later, replaced by phenprocoumon. After 1 week, she was discharged without any neurological symptoms.