Case report: cerebral sinus vein thrombosis in two patients with AstraZeneca SARS-CoV-2 vaccination

Fousse, Mathias; Schub, David; Merzou, Fatma; Faßbender, Klaus; Sester, Martina; Kettner, Mattias; Lochner, Piergiorgio; Schmidt, Tina; Júnior, João Reinoldo Goi

doi:10.1007/s00415-021-10731-2

Cited by 6 publications

(2 citation statements)

References 13 publications

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“…This description was a probable VITT case, given the lack of anti-PF4 positivity. Another paper from Germany has reported two women presenting with cerebral sinus vein thrombosis after the ChAdOx1 vaccine, each carrying an MTHFR variant (heterozygous A1298C and homozygous MTHFR C677T variant) ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

A case report of vaccine-induced immune thrombotic thrombocytopenia (VITT) with genetic analysis

Mendes-de-Almeida

Kehdy

Martins-Gonçalves

et al. 2023

Front. Cardiovasc. Med.

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The emergence of the rare syndrome called vaccine-induced immune thrombocytopenia and thrombosis (VITT) after adenoviral vector vaccines, including ChAdOx1 nCov-19, raises concern about one's predisposing risk factors. Here we report the case of a 56-year-old white man who developed VITT leading to death within 9 days of symptom onset. He presented with superior sagittal sinus thrombosis, right frontal intraparenchymal hematoma, frontoparietal subarachnoid and massive ventricular hemorrhage, and right lower extremity arterial and venous thrombosis. His laboratory results showed elevated D-dimer, C-reactive protein, tissue factor, P-selectin (CD62p), and positive anti-platelet factor 4. The patient's plasma promoted higher CD62p expression in healthy donors' platelets than the controls. Genetic investigation on coagulation, thrombophilia, inflammation, and type I interferon-related genes was performed. From rare variants in European or African genomic databases, 68 single-nucleotide polymorphisms (SNPs) in one allele and 11 in two alleles from common SNPs were found in the patient genome. This report highlights the possible relationship between VITT and genetic variants. Additional investigations regarding the genetic predisposition of VITT are needed.

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Section: Discussionmentioning

confidence: 99%

A case report of vaccine-induced immune thrombotic thrombocytopenia (VITT) with genetic analysis

Mendes-de-Almeida

Kehdy

Martins-Gonçalves

et al. 2023

Front. Cardiovasc. Med.

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show abstract

“…Early case reports of novel coronavirus pneumonia showed that up to 50% of patients had underlying diseases, and 40% of them had cardiovascular or cerebrovascular diseases (Xiong et al, 2020). There have been clinical studies reporting newly diagnosed cases of cerebral sinus vein thrombosis in patients with MTHFR mutations following injection of the vector-based ChAdOx1 COVID-19 vaccine (Fousse et al, 2022). Folic acid can minimize plasma homocysteine concentrations, thereby reducing risk factors for vascular disease.…”

Section: Discussionmentioning

confidence: 99%

Folic acid restricts SARS-CoV-2 invasion by methylating ACE2

Zhang

Pang

et al. 2022

Front. Microbiol.

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The current COVID-19 pandemic is motivating us to elucidate the molecular mechanism of SARS-CoV-2 invasion and find methods for decreasing its transmissibility. We found that SARS-CoV-2 could increase the protein level of ACE2 in mice. Folic acid and 5-10-methylenetetrahydrofolate reductase (MTHFR) could promote the methylation of the ACE2 promoter and inhibit ACE2 expression. Folic acid treatment decreased the binding ability of Spike protein, pseudovirus and inactivated authentic SARS-CoV-2 to host cells. Thus, folic acid treatment could decrease SARS-CoV-2 invasion and SARS-CoV-2-neutralizing antibody production in mice. These data suggest that increased intake of folic acid may inhibit ACE2 expression and reduce the transmissibility of SARS-CoV-2. Folic acid could play an important role in SARS-CoV-2 infection prevention and control.

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Azd-1222

2022

Reactions Weekly

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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.

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Case report: cerebral sinus vein thrombosis in two patients with AstraZeneca SARS-CoV-2 vaccination

Cited by 6 publications

References 13 publications

A case report of vaccine-induced immune thrombotic thrombocytopenia (VITT) with genetic analysis

A case report of vaccine-induced immune thrombotic thrombocytopenia (VITT) with genetic analysis

Folic acid restricts SARS-CoV-2 invasion by methylating ACE2

Azd-1222

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