Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report

Background and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, ho...

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Autores principales:	Albrecht Günther, Dirk Brämer, Mathias W. Pletz, Thomas Kamradt, Sabine Baumgart, Thomas E. Mayer, Michael Baier, Angelina Autsch, Christian Mawrin, Linda Schönborn, Andreas Greinacher, Thomas Thiele
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	vaccine COVID-19 thrombocytopenia cerebral thrombosis autoimmune case report Medicine R
Acceso en línea:	https://doaj.org/article/61ada4457095468f9fce453292077d0e
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spelling	oai:doaj.org-article:61ada4457095468f9fce453292077d0e2021-11-25T19:11:29ZComplicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report10.3390/vaccines91113442076-393Xhttps://doaj.org/article/61ada4457095468f9fce453292077d0e2021-11-01T00:00:00Zhttps://www.mdpi.com/2076-393X/9/11/1344https://doaj.org/toc/2076-393XBackground and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, how long symptomatic VITT can persist. Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies. Methods: Clinical and laboratory findings are presented, including the course of platelet counts, D-Dimer levels, clinical presentation, imaging, SARS-CoV-2-serological and immunological, platelet activating anti-PF4-IgG, as well as autopsy findings. Results: The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient’s serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage. Conclusions: Complicated VITT with extremely high anti-PF4-IgG titers over three months can induce recurrent thrombocytopenia despite treatment with IVIG and anticoagulation. Plasma exchange, immunoadsorption, and /or immunosuppressive treatment may be considered in complicated VITT to reduce extraordinarily high levels of anti-PF4-IgG. Long-term therapy in such cases must take the individual bleeding risk and CSVT risk into account.Albrecht GüntherDirk BrämerMathias W. PletzThomas KamradtSabine BaumgartThomas E. MayerMichael BaierAngelina AutschChristian MawrinLinda SchönbornAndreas GreinacherThomas ThieleMDPI AGarticlevaccineCOVID-19thrombocytopeniacerebral thrombosisautoimmunecase reportMedicineRENVaccines, Vol 9, Iss 1344, p 1344 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	vaccine COVID-19 thrombocytopenia cerebral thrombosis autoimmune case report Medicine R
spellingShingle	vaccine COVID-19 thrombocytopenia cerebral thrombosis autoimmune case report Medicine R Albrecht Günther Dirk Brämer Mathias W. Pletz Thomas Kamradt Sabine Baumgart Thomas E. Mayer Michael Baier Angelina Autsch Christian Mawrin Linda Schönborn Andreas Greinacher Thomas Thiele Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
description	Background and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, how long symptomatic VITT can persist. Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies. Methods: Clinical and laboratory findings are presented, including the course of platelet counts, D-Dimer levels, clinical presentation, imaging, SARS-CoV-2-serological and immunological, platelet activating anti-PF4-IgG, as well as autopsy findings. Results: The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient’s serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage. Conclusions: Complicated VITT with extremely high anti-PF4-IgG titers over three months can induce recurrent thrombocytopenia despite treatment with IVIG and anticoagulation. Plasma exchange, immunoadsorption, and /or immunosuppressive treatment may be considered in complicated VITT to reduce extraordinarily high levels of anti-PF4-IgG. Long-term therapy in such cases must take the individual bleeding risk and CSVT risk into account.
format	article
author	Albrecht Günther Dirk Brämer Mathias W. Pletz Thomas Kamradt Sabine Baumgart Thomas E. Mayer Michael Baier Angelina Autsch Christian Mawrin Linda Schönborn Andreas Greinacher Thomas Thiele
author_facet	Albrecht Günther Dirk Brämer Mathias W. Pletz Thomas Kamradt Sabine Baumgart Thomas E. Mayer Michael Baier Angelina Autsch Christian Mawrin Linda Schönborn Andreas Greinacher Thomas Thiele
author_sort	Albrecht Günther
title	Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title_short	Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title_full	Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title_fullStr	Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title_full_unstemmed	Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title_sort	complicated long term vaccine induced thrombotic immune thrombocytopenia—a case report
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/61ada4457095468f9fce453292077d0e
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Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report

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