Symptomatic peduncular, cavernous bleeding following SARS-CoV-2 vaccination induced immune thrombocytopenia

Abstract

Therapy-responsive immune thrombocytopenia and anemia shortly after the second dose of an mRNA-based SARS-CoV-2 vaccine, which was complicated by symptomatic bleeding within a pre-existing brainstem cavernoma, has not been reported. The patient is a 68yo male who experienced gait disturbance and hypoesthesia of the left face and left upper extremity two days after the second dose of the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Tozinameran). Clinical neurologic exam revealed hypoesthesia of the left face and the left upper extremity and ataxic gait. Blood tests revealed macrocytic anemia and marked thrombocytopenia, interpreted as vaccination induced immune thrombocytopenia (ITP). Cerebral MRI revealed subacute bleeding within a pre-existing solitary cavernoma located in the right cerebellar peduncle. With proceeding resorption of the bleeding, symptoms gradually regressed. This case shows that SARS-CoV-2 vaccinations may be followed by ITP and bleeding in pre-existing vascular malformations, In order to avoid cavernoma bleeding in patients with SARS-CoV-2 vaccination associated ITP and thrombocyte dysfunction, urgent treatment of ITP is warranted. In order to identify patients at risk for experiencing SARS-CoV-2 vaccination induced ITP, further studies are urgently warranted.

Thrombosis post-mRNA-based SARS-CoV-2 vaccination (BNT162b2) – Time to think beyond thrombosis with thrombocytopenia syndrome (TTS)

“…There are 16 cases of ITP, 12 cases of TTP reactivation, 11 cases of suspected intracerebral hemorrhage (ICH), 6 cases of cerebral venous sinus thrombosis, 1 case of pulmonary embolism, 1 case of renal thrombotic microangiopathy, a case of ST-elevation myocardial infarction (STEMI), 1 case of stroke, 1 case of central retinal artery occlusion, and a case of lower limb DVT associated with BNT162b2( Fig. 1 ) [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] ]. The STEMI reported in an elderly gentleman with multiple cardiovascular and pro-thrombotic risk factors 30mins post first dose of BNT162b2 is attributed to vaccination-induced “Kounis syndrome” or allergic myocardial infarction likely secondary to mast cell activation from an allergic or anaphylactoid reaction [ 11 ].…”

Spinal intramedullary cavernous angioma patient in a pain clinic - A case report -

“…Finsterer and Redzic [ 4 ] reported a brainstem cavernous hemangioma hemorrhage that occurred 2 days after the second dose of the mRNA COVID-19 vaccine, the pre-existing vascular malformation might have caused bleeding due to thrombocytopenia or platelet dysfunction after vaccination. Also, Gessler et al [ 5 ] reported 3 cases of intracerebral hemorrhage with thrombocytopenia after vaccination with Oxford/AstraZeneca and Janssen vaccines.…”

Special considerations and pitfalls for intracerebral bleeding followed COVID-19 case treated by ECMO

“…Dysregulated immune responses in COVID cases can contribute to the production of immune-mediated processes via activation of different inflammation-related cells and production of cytokines, resulting in a wide range of clinical manifestations, such as Guillain-Barré Syndrome (GBS) [8] . Also, those processes can lead to ICB as a result of dysfunctional thrombocytes [9] . In our case [2] the patient D-dimer was high (14 μg/ml) with thrombocytopenia which improved through hospital stay.…”