Case mistaken for leukemia after mRNA COVID-19 vaccine administration: A case report

Table 1 Laboratory data at admission

Laboratory parameter	Result	Normal range
WBC (/μL)	11590	4000-10000
Neutrophil (%)	58.7	40-80
Lymphocyte (%)	31.2	25-50
Monocyte (%)	9.8	0-9
Eosinophil (%)	0.1	0-7
Basophil (%)	0.2	0-1.8
Platelet (/μL)	38000	150000-400000
AST (U/L)	242	5-40
ALT (U/L)	73.5	5-40
Total bilirubin (mg/dL)	6.5	0.2-1.2
CRP (mg/dL)	> 16	0.0-0.3

WBC: White blood cell; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CRP: C-reactive protein.

Table 2 Infectious disease diagnostic test results

Diseases	Result
COVID-19	Negative
Ebstein-Barr virus	Negative
Cytomegalovirus	Negative
Hepatitis A	Negative
Hepatitis B	Negative
Hepatitis C	Negative
Hantavirus	Negative
HIV	Negative
Rickettsia tsutsugamushi	Negative
Leptospira	Negative
Blood bacterial culture	Negative
Urine bacterial culture	Negative

COVID-19: Coronavirus disease 2019; HIV: Human immunodeficiency virus.

Table 3 Evaluation of autoimmune hepatitis

Laboratory parameter	Results	Normal range
Anti LKM-1 Ab	Negative	Negative
Anti-mitochondria Ab	Negative	Negative
ANA (titer)	Centromere 1:1280
Anti dsDNA antibody (IU/mL)	Negative < 10	10-15
p-ANCA (IU/mL)	Negative < 0.1	0-3.5

Anti LKM-1 Ab: Anti liver kidney microsomal antibody; ANA: Antinuclear antibody; ANCA: Anti neutrophil cytoplasmic antibody.

Table 4 Hematologic adverse events except for thrombocytopenic syndrome

Types of hematologic adverse events	Patient No. and Ref.	Age, yr	Sex	Symptom onset (No. of days after vaccination)	Symptoms	Underlying diseases	Type of vaccine	Outcome
ITP	1, Tarawneh and Tarawneh[31]	22	M	3	Petechia, gum bleeding	None	Pfizer	Recovery
	2-9, Lee et al[26]	NA	NA	NA	NA	NA	Pfizer	NA
	10-20, Lee et al[26]	NA	NA	NA	NA	NA	Moderna	NA
	21, Shah et al[27]	53	M	8	Petechia rash, myalgia	Crohn’s disease	Pfizer	Recovery
	22, Shah et al[27]	67	M	2	Melena	Chronic ITP	Pfizer	Recovery
	23, Shah et al[27]	59	F	2	Bloody diarrhea	SLE, chronic ITP	J&J	Recovery
	24, Ganzel and Ben-Chetrit[25]	53	M	14	Epistaxis	DM, HTN, otitis	Pfizer	Recovery
	25, Toom et al[32]	36	F	14	Petechia, bruising, gum bleeding, headache	ITP	Moderna	Recovery
	26, Paulsen et al[28]	72	M	11	Petechia, epistaxis, headache	Autoimmune thyroiditis	AZD1222	NA
	27 Paulsen et al[28]	71	F	11	Petechia, hyposphagma	Latent hyperthyroidism, breast cancer, stroke	AZD1222	NA
	28 Paulsen et al[28]	66	M	2	Petechia	HTN, mild thrombocytopenia	AZD1222	NA
	29 Paulsen et al[28]	64	F	15	None	HTN, COPD, steatosis hepatitis	AZD1222	NA
	30, Ghosh et al[33]	63	F	2	Bruise	COPD, Type 2 DM	Pfizer	Recovery
AIHA	30, Gaignard et al[13]	56	M	3	Painless petechia	Evans syndrome	Moderna	Recovery
	31, Gaignard et al[13]	77	M	5	Weakness, fatigue, shortness of breath	none	Moderna	Recovery
	32, Murdych[16]	84	M	19	Urinary frequency, dizziness	Prostate & colon cancer, CAD, HTN, trace cryoglobulinemia, emphysema, mild chronic anemia, major depression and/or anxiety	Pfizer	Recovery
	33, Brito et al[24]	88	F	2	Asthenia, jaundice	Insomnia	mRNA vaccine	Recovery
Hemolytic crisis	35, Pérez-Lamas et al[15]	57	F	2	Chills, weakness, exertional dyspnea, jaundice, mild hemoglobinurina	Cold agglutinin disease	mRNA vaccine	Recovery
Hemolysis	36, Gerber et al[14]	25	M	5	Abdominal pain	PNH	Pfizer	NA
	37, Gerber et al[14]	45	M	0	Fever, headache, myalgia, fatigue, hemoglobinuria	PNH	Pfizer	NA
	37, Gerber et al[14]	32	F	0	Fever, rigor	PNH	Moderna	NA
	38, Gerber et al[14]	63	M	0	Fatigue, darkening urine	PNH	Moderna	NA

ITP: Immune thrombocytopenia; AIHA: Autoimmune hemolytic anemia; M: Male; NA: Not available; F: Female; SLE: Systemic lupus erythematosus; DM: Diabetes mellitus; HTN: Hypertension; COPD: Chronic obstructive pulmonary disease; CAD: Coronary artery disease; PNH: Paroxysmal nocturnal hemoglobinuria.