Acquired thrombotic thrombocytopenic purpura: A rare disease associated with BNT162b2 vaccine

H, Maayan; Kirgner, Ilya; Gutwein, Odit; Herzog-Tzarfati, Katrin; Rahimi‐Levene, Naomi; Koren‐Michowitz, Maya; Blickstein, Dorit

doi:10.1111/jth.15420

Cited by 44 publications

(52 citation statements)

References 17 publications

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“…Globally, during the last 50 years only a few cases of TTP have been documented for influenza vaccines (Table 3) (139), even though 3100 million seasonal influenza vaccine doses have been administered in the United States of America alone since 1980 (140). A similar remark can be made of COVID vaccines, where, at the time of writing, only 2 cases of relapsing iTTP (134,135) and 8 de novo iTTP cases (136)(137)(138)141) were identified, among many millions of doses administered currently in the world. In this context, it is important not to confuse iTTP with vaccineinduced thrombotic thrombocytopenia (VITT), which has different mechanisms compared to iTTP (142,143).…”

Section: Some Reports Described An Association Between Vaccine Administration and Development Of Ittp (Examples Listed Inmentioning

confidence: 91%

Emerging Concepts in Immune Thrombotic Thrombocytopenic Purpura

2021

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Immune thrombotic thrombocytopenic purpura (iTTP) is an autoimmune disorder of which the etiology is not fully understood. Autoantibodies targeting ADAMTS13 in iTTP patients have extensively been studied, the immunological mechanisms leading to the breach of tolerance remain to be uncovered. This review addresses the current knowledge on genetic factors associated with the development of iTTP and the interplay between the patient’s immune system and environmental factors in the induction of autoimmunity against ADAMTS13. HLA-DRB1*11 has been identified as a risk factor for iTTP in the Caucasian population. Interestingly, HLA-DRB1*08:03 was recently identified as a risk factor in the Japanese population. Combined in vitro and in silico MHC class II peptide presentation approaches suggest that an ADAMTS13-derived peptide may bind to both HLA-DRB1*11 and HLA-DRB1*08:03 through different anchor-residues. It is apparent that iTTP is associated with the presence of infectious microorganisms, viruses being the most widely associated with development of iTTP. Infections may potentially lead to loss of tolerance resulting in the shift from immune homeostasis to autoimmunity. In the model we propose in this review, infections disrupt the epithelial barriers in the gut or lung, promoting exposure of antigen presenting cells in the mucosa-associated lymphoid tissue to the microorganisms. This may result in breach of tolerance through the presentation of microorganism-derived peptides that are homologous to ADAMTS13 on risk alleles for iTTP.

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Section: Some Reports Described An Association Between Vaccine Administration and Development Of Ittp (Examples Listed Inmentioning

confidence: 91%

Emerging Concepts in Immune Thrombotic Thrombocytopenic Purpura

2021

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“…Petechial eruptions were described as a possible consequence of immune thrombocytopenic purpura following mRNA vaccination. Some cases were accompanied by systemic signs/symptoms like weakness, shortness of breath, leg edema, nausea, vomiting, and abdominal pain [32][33][34]. A petechial rash of the trunk was even reported in a patient with anaphylactic symptoms [35].…”

Section: Vascular Lesionsmentioning

confidence: 99%

Cutaneous Adverse Reactions Associated with SARS-CoV-2 Vaccines

Bellinato

Maurelli

Gisondi

et al. 2021

JCM

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Many patients are receiving SARS-CoV-2 vaccinations, which have been associated with a variety of adverse effects. Cutaneous adverse reactions to SARS-CoV-2 vaccinations have been progressively reported, but they have not been reviewed according to their morphological clinical patterns. The objective of this review was to summarize the existing data concerning the cutaneous adverse reactions following SARS-CoV-2 vaccines and group them according to common morphological and pathogenetic patterns. We reviewed the English language literature up to 15 August 2021, using predefined keywords to identify the relevant studies evaluating cutaneous adverse reactions associated with SARS-CoV-2 vaccines. We search for recurrent morphological patterns sharing clinical signs and symptoms and physio-pathological mechanisms. Timing to onset following the first or booster dose of the vaccine, predisposing conditions, therapeutic management, and outcome were also collected. Among the dermatological manifestations associated with SARS-CoV-2 vaccinations, we distinguished: (1) new onset reactions and (2) flares of preexisting dermatoses. The most common were injection site reactions, affecting 30–70% and generally mild or moderate. Small case series or single case reports included filler reactions, exanthemas, vascular lesions, urticaria, eczematous dermatitis, autoimmune bullous reactions, and severe cutaneous adverse reactions. In addition, the exacerbation of chronic immuno-mediated dermatoses (mainly psoriasis and atopic dermatitis) and reactivations of herpes infection were reported. The cutaneous reactions were generally mild, self-limiting, and resembled common cutaneous drug eruptions and/or COVID-19 skin manifestations.

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“…The immune derangement induced by either vectored or mRNA vaccination can cause newly developed or relapsed TTP [ 61 , 62 ]. Lately, a new pathologic insight of this unique hematologic disorder, TTP associated with COVID-19 mRNA vaccine, has been reported.…”

Section: Differential Diagnosismentioning

confidence: 99%