Jiang SK, Chen WL, Chien C, Pan CS, Tsai ST. Rapid progressive vaccine-induced immune thrombotic thrombocytopenia with cerebral venous thrombosis after ChAdOx1 nCoV-19 (AZD1222) vaccination: A case report. World J Clin Cases 2022; 10(26): 9462-9469 [PMID: 36159410 DOI: 10.12998/wjcc.v10.i26.9462]
Corresponding Author of This Article
Sheng-Ta Tsai, MD, PhD, Attending Doctor, Department of Neurology, China Medical University Hospital, No. 2 Yude Road, North District, Taichung 404332, Taiwan. tshengdar@gmail.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 16, 2022; 10(26): 9462-9469 Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9462
Rapid progressive vaccine-induced immune thrombotic thrombocytopenia with cerebral venous thrombosis after ChAdOx1 nCoV-19 (AZD1222) vaccination: A case report
Shin-Kuang Jiang, Wei-Liang Chen, Chun Chien, Chi-Syuan Pan, Sheng-Ta Tsai
Shin-Kuang Jiang, Sheng-Ta Tsai, Department of Neurology, China Medical University Hospital, Taichung 404332, Taiwan
Wei-Liang Chen, Department of Radiology, China Medical University Hospital, Taichung 404332, Taiwan
Chun Chien, Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu 30272, Taiwan
Chi-Syuan Pan, Department of Emergency, China Medical University Hospital, Taichung 404332, Taiwan
Sheng-Ta Tsai, Neuroscience and Brain Disease Center, China Medical University, Taichung 404332, Taiwan
Author contributions: Jiang SK and Tsai ST were the patient’s chief attending doctor during hospitalization, collected the patient‘s clinical data, reviewed the literature, and contributed to manuscript drafting; Jiang SK drafted the manuscript; Pan CS was the doctor in emergency department who evaluated her first and was alert to this syndrome; Chien C reviewed the literature and contributed to manuscript drafting; Chen WL analyzed and interpreted the imaging findings and he was consulted for endovascular therapy; Tsai ST was responsible for the revision of the manuscript for important intellectual content; and All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying image.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Ta Tsai, MD, PhD, Attending Doctor, Department of Neurology, China Medical University Hospital, No. 2 Yude Road, North District, Taichung 404332, Taiwan. tshengdar@gmail.com
Received: April 26, 2022 Peer-review started: April 26, 2022 First decision: June 8, 2022 Revised: June 20, 2022 Accepted: August 1, 2022 Article in press: August 1, 2022 Published online: September 16, 2022 Processing time: 128 Days and 14.9 Hours
Abstract
BACKGROUND
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines. It is characterized by symptom onset at 5 to 30 d postvaccination, thrombocytopenia, thrombosis, high D-dimer level, and antiplatelet factor 4 (anti-PF4) antibody positivity. VITT can progress very fast, requiring urgent management. Only few studies have described its detailed clinical course and imaging changes. We report a typical VITT case in a patient who underwent regular repeated brain imaging examinations.
CASE SUMMARY
A young woman presented with headaches at 7 d after the ChAdOx1 nCoV-19 vaccine (AZD1222) injection. She then showed progressive symptoms of left upper limb clumsiness. Brain computed tomography revealed venous infarction at the right parietal lobe with a hyperacute thrombus in the cortical vein. Two hours later, brain magnetic resonance imaging revealed hemorrhage at the same area. Magnetic resonance venography showed an irregular contour of the right transverse sinus. Laboratory examination revealed a high D-dimer level, thrombocytopenia, and a high titer for anti-PF4 antibodies. She was treated with anticoagulants, intravenous immunoglobulin, and steroids and analgesic agents were administered for pain control. She had a marked improvement on headaches and clumsiness after treatment along with radiological thrombus resolution. During follow-up at the outpatient department, her modified Rankin scale at 90 d was 1.
CONCLUSION
Clinicians should be alerted whenever patients present with persistent and progressive headaches or focal motor/sensory deficits postvaccination.
Core Tip: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare and potentially life-threatening condition. Only few studies have described the detailed clinical course and imaging changes in patients with VITT. We report a typical case of VITT in a patient presenting with headaches 7 d postvaccination with progressive left upper limb clumsiness. A series of brain imaging examinations revealed venous infarction, which can progress very fast. Our case demonstrated that VITT diagnosis can be delayed. Clinicians should be alerted whenever a patient with a persistent and progressive headaches or focal motor/sensory deficits after vaccination also presents with high D-dimer level and thrombocytopenia.
