Very severe immune thrombocytopenia following SARS-CoV-2 vaccination requiring splenectomy: a case report

Abstract

Background Some conventional vaccines have been recognized as a cause of secondary immune thrombocytopenia (ITP). According to recent publications, mRNA vaccines are probably associated with an increased risk of ITP. Case presentation Our patient developed severe ITP one week after the second dose of COVID-19 mRNA vaccine. Medical management was not effective, requiring splenectomy to obtain sustained remission. Conclusion Considering the temporality and immunological hypothesis, we consider the vaccine to be the trigger of this ITP. To our knowledge, our case is, to date, the most severe case of ITP reported following SARS-CoV-2 vaccination and could help for the therapeutic management of similar patients.

Immune Thrombocytopenia After COVID-19 Vaccine Requiring Splenectomy: A Case Report and Review of the Literature

“…However, familial predisposition may not be a consistent risk factor for vaccine-induced ITP, as our case did not have a family history of any autoimmune diseases. Unlike the previously reported cases where symptoms emerged one to two weeks after the second dose of the COVID-19 vaccine [ 5 - 7 ], our case experienced symptoms one week after the first dose and responded well to initial ITP management.…”

“…Table 1 summarizes the reported cases in the literature. None of the documented cases had pre-existing ITP, although two patients had a family history of autoimmune disease or ITP in a family member [ 5 , 7 ]. This suggests a possible genetic predisposition to developing ITP.…”

“…We present a unique case of severe and refractory ITP requiring intensive treatment, including splenectomy. As of date, there have been only three cases in the literature of ITP post COVID-19 vaccine requiring splenectomy [ 5 - 7 ]. We present a case of a patient who developed severe refractory ITP two weeks after receiving the COVID-19 vaccine.…”

Expert Report on Immune Thrombocytopenia: Current Diagnostics and Treatment – Recommendations from an Expert Group from Austria, Germany, and Switzerland

“…There are numerous reports that COVID can trigger the first onset of ITP [105][106][107][108][109][110][111][112][113], which would then be classified as newly diagnosed secondary ITP. In some COVID-19 patients, the platelet count may be very low, and severe hemorrhage, including CNS bleeding, has been described [106,107,109,112].…”

Expertenreport Immunthrombozytopenie – Aktuelle Diagnostik und Therapie

“…COVID-19 und ITP Es gibt mittlerweile zahlreiche Berichte, dass im Rahmen einer COVID-19 Erkrankung eine ITP-Erkrankung neu auftreten kann [105][106][107][108][109][110][111][112][113]. Bei einigen COVID-19 Patient*innen fallen die Thrombozytenwerte bis unter 1'000/µL und zumindest in Einzelfällen sind auch schwere Blutungen, bis hin zu ZNS-Blutungen beschrieben [106,107,109,112].…”