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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: Günther, Albrecht, Brämer, Dirk, Pletz, Mathias W., Kamradt, Thomas, Baumgart, Sabine, Mayer, Thomas E., Baier, Michael, Autsch, Angelina, Mawrin, Christian, Schönborn, Linda, Greinacher, Andreas, Thiele, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622649/
https://www.ncbi.nlm.nih.gov/pubmed/34835275
http://dx.doi.org/10.3390/vaccines9111344
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author Günther, Albrecht
Brämer, Dirk
Pletz, Mathias W.
Kamradt, Thomas
Baumgart, Sabine
Mayer, Thomas E.
Baier, Michael
Autsch, Angelina
Mawrin, Christian
Schönborn, Linda
Greinacher, Andreas
Thiele, Thomas
author_facet Günther, Albrecht
Brämer, Dirk
Pletz, Mathias W.
Kamradt, Thomas
Baumgart, Sabine
Mayer, Thomas E.
Baier, Michael
Autsch, Angelina
Mawrin, Christian
Schönborn, Linda
Greinacher, Andreas
Thiele, Thomas
author_sort Günther, Albrecht
collection PubMed
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.
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spelling pubmed-86226492021-11-27 Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report Günther, Albrecht Brämer, Dirk Pletz, Mathias W. Kamradt, Thomas Baumgart, Sabine Mayer, Thomas E. Baier, Michael Autsch, Angelina Mawrin, Christian Schönborn, Linda Greinacher, Andreas Thiele, Thomas Vaccines (Basel) 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, 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. MDPI 2021-11-17 /pmc/articles/PMC8622649/ /pubmed/34835275 http://dx.doi.org/10.3390/vaccines9111344 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Günther, Albrecht
Brämer, Dirk
Pletz, Mathias W.
Kamradt, Thomas
Baumgart, Sabine
Mayer, Thomas E.
Baier, Michael
Autsch, Angelina
Mawrin, Christian
Schönborn, Linda
Greinacher, Andreas
Thiele, Thomas
Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title 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_short Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia—A Case Report
title_sort complicated long term vaccine induced thrombotic immune thrombocytopenia—a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622649/
https://www.ncbi.nlm.nih.gov/pubmed/34835275
http://dx.doi.org/10.3390/vaccines9111344
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