Fatal vaccine-induced immune thrombotic thrombocytopenia (VITT) post Ad26.COV2.S: first documented case outside US.

Autor: Rodriguez EVC; Department of Emergency Medicine, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Bouazza FZ; Department of Emergency Medicine, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Dauby N; Department of Infectious Diseases, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Mullier F; Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université catholique de Louvain (UCL), Yvoir, Belgium., d'Otreppe S; Department of Laboratory Medicine, LHUB-ULB, Université libre de Bruxelles (ULB), Brussels, Belgium., Jissendi Tchofo P; Department of Radiology, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Bartiaux M; Department of Emergency Medicine, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Sirjacques C; Department of Intensive Care Medicine, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Roman A; Department of Intensive Care Medicine, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium., Hermans C; Division of Hematology, Hemostasis and Thrombosis Unit, Saint-Luc University Hospital, Université catholique de Louvain (UCL), Brussels, Belgium., Cliquennois M; Department of Clinical Hematology, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Rue Haute 322, 1000, Brussels, Belgium. manuel.cliquennois@gmail.com.
Jazyk: angličtina
Zdroj: Infection [Infection] 2022 Apr; Vol. 50 (2), pp. 531-536. Date of Electronic Publication: 2021 Oct 09.
DOI: 10.1007/s15010-021-01712-8
Abstrakt: Purpose: We reported the first described post Ad26.COV2.S (Janssen, Johnson & Johnson) vaccine-induced immune thrombocytopenia (VITT) case outside US.  CASE DESCRIPTION: CA young woman without any medical history presented association of deep vein thrombosis and thrombocytopenia at day 10 after vaccine injection. The patient was treated with low-molecular weight heparin at a first medical institution. Twelve days post Ad26.COV2.S vaccination, the patient was admitted at our hospital for neurological deterioration and right hemiplegia. Medical imaging using MRI showed thrombosis of the major anterior part of the sagittal superior sinus with bilateral intraparenchymal hemorrhagic complications. Screening tests for antibodies against platelet factor 4 (PF4)-heparin by rapid lateral flow immunoassay and chemiluminescence techniques were negative. Platelet activation test using heparin-induced multiple electrode aggregometry confirmed the initial clinical hypothesis. Despite immediate treatment with intravenous immunoglobulin, dexamethasone, danaparoid and attempted neurosurgery the patient evolved toward brain death.
Conclusion: Even though it is an extremely rare complication of vaccination physicians should maintain a high index of suspicion of VITT in patients who received an adenovirus-vector-based SARS-CoV-2 vaccine within the last 30 days with persistent complains compatible with VITT or thromboembolic event associated with thrombocytopenia. The diagnosis should not be excluded if the rapid anti-PF4 immunological nor chemiluminescence techniques yield negative results. An adapted functional assay should be performed to confirm the diagnosis. Early treatment with intravenous immunoglobulin and non-heparin anticoagulants is essential as delayed diagnosis and administration of appropriate treatment is associated with poor prognosis.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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