Deep vein thrombosis and acute hepatitis after ChAdOx1 nCov-19 vaccination in a Charcot-Marie-Tooth patient: a case report

Monitoring of side effects after coronavirus disease 2019 (COVID-19) vaccination has become an important issue for health systems worldwide to ensure its safety. Recently cases of deep vein thrombosis (DVT), vaccine-induced immune thrombotic thrombocytopenia, and autoimmune hepatitis have been described: the underlying pathophysiological mechanisms are still debated. We report on a patient who presented with DVT and acute hepatitis 8 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against COVID-19. The patient is a 56-year-old male who was already affected by a rare form of axonal Charcot-Marie-Tooth disease linked to MME (membrane metalloendopeptidase) gene variation and associated with mild symptoms. His blood exams did not have any evidence of thrombocytopenia but D-dimer, troponin T, alanine transaminase, and aspartate aminotransferase were abnormal, suggesting the presence of a blood clot and acute hepatitis. The patient was treated with subcutaneous enoxaparin for 15 days and with rivaroxaban for the following 8 months: his symptoms improved and his exams showed recanalization of the veins and a healed liver. The pathogenesis of thrombosis and hepatitis after vaccination is still unclear, especially in subjects affected by rare comorbidities and this may affect the safety of vaccination in this type of population. We highlight the importance of careful monitoring of side effects after vaccination: clinical suspicion must rise when patients complain of symptoms that differ from their usual presentation.