Immune thrombocytopenic purpura and acute liver injury after COVID-19 vaccine

Abstract

A 26-year-old woman was sent to the emergency room by her primary care physician for a new petechial rash and thrombocytopenia 2 weeks after receiving the Moderna mRNA-1273 SARS-CoV-2 vaccine. Her hospital course was complicated by transaminitis. Her platelet count improved to normal on hospital day 5 after receiving intravenous steroids and intravenous immunoglobulin to treat her suspected diagnosis of immune thrombocytopenic purpura. Extensive workup for her thrombocytopenia and transaminitis was unremarkable including ruling out infectious, autoimmune and toxic causes. A liver biopsy was unrevealing and her transaminitis was improved on discharge. Although not proven, the temporal relationship of her vaccination with thrombocytopenia and abnormal liver enzymes points towards the Moderna mRNA-1273 SARS-CoV-2 vaccine as the most likely inciting factor.

COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review

“…Cases of ITP and TTP after mRNA-1273 COVID-19 vaccine have been documented since the early vaccination campaign (165)(166)(167)(168). A flare of familial thrombocytopenia has been r e p o r t e d a s w e l l ( 1 6 9 ) .…”

Drug-induced hepatitis after Sinopharm COVID-19 vaccination: A case study of a 62-year-old patient

“…Mild side effects, which are the most common, include swelling at injection site, fever and myalgia. However, more serious side effects such as seizure, life-threatening allergic reactions and thrombocytopenia have been reported as well [2] , [4] . Some trials also reported decreased hemoglobin, increased bilirubin, elevated AST (aspartate aminotransferase) and ALT (alanine aminotransferase) [5] .…”

Immune thrombocytopenia following ChAdOx1 vaccine and positive rechallenge with BNT162b2 vaccine: A case report with pharmacovigilance analysis

“…Hematological events such as ITP has already been related to the use of vaccines, specifically live attenuated vaccines such as measles, mumps and rubella [4] . The onset of vaccine-related ITP usually has a time relationship, occurring mainly within 42 days after vaccination [5] . Since the beginning of the COVID-19 mass immunization campaign, several case-reports or case-series of ITP following vaccination have been described in the literature [5] , [6] , [7] , [8] .…”

“…The onset of vaccine-related ITP usually has a time relationship, occurring mainly within 42 days after vaccination [5] . Since the beginning of the COVID-19 mass immunization campaign, several case-reports or case-series of ITP following vaccination have been described in the literature [5] , [6] , [7] , [8] . In some cases, underlying autoimmune medical conditions may have contributed to the ITP occurrence but it appears infrequent [8] .…”