Case Report: A Case of COVID Vaccine-Induced Thrombotic Thrombocytopenia Manifested as Pulmonary Embolism and Hemorrhagia. A First Reported Case From Slovakia

Ihnatko, Martin; Truchla, Ivana; Ihnatková, L'udmila; Prohászka, Zoltán; Lazúrová, Ivica

doi:10.3389/fmed.2021.789972

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…In differential diagnosis, VITT was considered in our patient ( 29 ). This rare complication occurs after vaccination with adenovirus vaccines with a frequency of 3–10/million vaccinated ( 30 ). It usually arises after the first dose of the vaccine and can manifest itself in thrombocytopenia, thrombosis in the cerebral venous sinus or in splanchnic veins, thromboembolism into the cerebral arteries, or signs of TMA.…”

Section: Discussionmentioning

confidence: 99%

Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report

et al. 2022

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Atypical hemolytic uremic syndrome (aHUS), also called complement-mediated hemolytic uremic syndrome (CM-HUS), is a rare disease caused by dysregulation in the alternative complement activation pathway. It is a life-threatening condition causing ischemia of a number of organs, and it typically causes acute kidney injury. This disorder may be triggered by various factors including viral or bacterial infections, pregnancy, surgery, and injuries. In about 60% of cases, the genetic origin of the disease can be identified—commonly mutations affecting complementary factor H and MCP protein. Eculizumab, a monoclonal antibody to the C5 component of the complement, represents the current effective treatment.We describe a case of a young woman with a previous history of polyvalent allergies, who developed atypical hemolytic uremic syndrome after vaccination with mRNA vaccine against SARS-CoV-2. The disease manifested by scleral bleeding, acute renal insufficiency, anemia, and thrombocytopenia. The patient was treated with plasma exchanges without sufficient effect; remission occurred only after starting treatment with eculizumab. Genetic examination showed that the patient is a carrier of multiple inherited risk factors (a rare pathogenic variant in CFH, MCPggaac haplotype of the CD46 gene, and the risk haplotype CFH H3). The patient is currently in hematological remission with persistent mild renal insufficiency, continuing treatment with eculizumab/ravulizumab. By this case report, we meant to point out the need for careful monitoring of people after vaccination, as it may trigger immune-mediated diseases, especially in those with predisposing factors.

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Section: Discussionmentioning

confidence: 99%

Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report

et al. 2022

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“…The absence of genetic predisposition in our patients raised the possibility of vaccine induced thrombotic thrombocytopenia (VITT) as a potential diagnosis rather than aHUS. However, the negative essay for anti-PF-4 and the absence of thrombotic events made the diagnosis of VITT less likely [ 20 , 21 ]. We believe that our patient had aHUS and the AstraZeneca SARS-CoV-2 vaccine was the trigger, given the short period between vaccination administration and the development of the disease.…”

Section: Discussionmentioning

confidence: 99%

End-Stage Kidney Disease Resulting from Atypical Hemolytic Uremic Syndrome after Receiving AstraZeneca SARS-CoV-2 Vaccine: A Case Report

et al. 2023

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Hemolytic uremic syndrome (HUS) is classically described as a triad of nonimmune hemolytic anemia, thrombocytopenia, and acute kidney injury. Atypical HUS (aHUS) is a rare variant of the disease, and it accounts for 5–10% of the cases. It has a poor prognosis, with a mortality rate exceeding 25% and a more than 50% chance of progressing into end-stage kidney disease (ESKD). Genetic or acquired dysregulation of the alternative complement pathway is highly implicated in the pathogenesis of aHUS. Multiple triggers for aHUS have been described in the literature, including pregnancy, transplantation, vaccination, and viral infections. Herein, we report a case of a previously healthy 38-year-old male who developed microangiopathic hemolytic anemia and severe kidney impairment one week after receiving the first dose of AstraZeneca SARS-CoV-2 vaccine. A diagnosis of aHUS was made after excluding other causes of thrombotic microangiopathies. Treatment with plasma exchange, prednisone, and rituximab (375 mg/m2) once weekly for four doses resulted in improvement of his hematological parameters. However, he progressed to ESKD.

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“…Non-heparin anticoagulants and immunoglobulins may help treat VITT/TTS. [21] Anticoagulation alone or in combination with eculizumab or IVIg resolved the pathology in three patients. [21] Treatment with fondaparinux, IVIg, and prednisone led to a marked improvement of VITT.…”

Section: Of Treatmentsmentioning

confidence: 95%

“…[21] Anticoagulation alone or in combination with eculizumab or IVIg resolved the pathology in three patients. [21] Treatment with fondaparinux, IVIg, and prednisone led to a marked improvement of VITT. Treatments including IVIg, methylprednisolone and direct oral anticoagulant improved VITT gradually.…”

Section: Of Treatmentsmentioning

confidence: 95%

SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia: A comprehensive review, release 2 (immunologic perspective)

Tizaoui,

Zidi,

Rahmati

et al. 2023

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Thromboembolism remains an extremely rare side effect of COVID-19 vaccination, and the benefits of vaccination against COVID-19 continue to outweigh the risks of side effects. The scientific community should have confidence in the safety of the SARS-CoV-2 vaccines when considering solutions to unwanted side effects. This study explores the intricate immunological pathways associated with vaccine-induced immune thrombotic thrombocytopenia (VITT), focusing on the COVID-19 vaccine. The development of VITT is linked to thrombosis, where viral proteins and free DNA in the vaccine bind to platelet factor 4, generating a neo-antigen that induces the production of antibodies promoting platelet activation and clotting. The study sheds light on the complex immunological responses contributing to VITT and its distinction from related syndromes.

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Case Report: A Case of COVID Vaccine-Induced Thrombotic Thrombocytopenia Manifested as Pulmonary Embolism and Hemorrhagia. A First Reported Case From Slovakia

Cited by 7 publications

References 20 publications

Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report

Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report

End-Stage Kidney Disease Resulting from Atypical Hemolytic Uremic Syndrome after Receiving AstraZeneca SARS-CoV-2 Vaccine: A Case Report

SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia: A comprehensive review, release 2 (immunologic perspective)

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