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A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine

Authors

Laura Pini
laura.pini@unibs.it
https://orcid.org/0000-0001-6563-4942
Respiratory Medicine Unit; UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Paolo Malerba
2UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Internal Medicine, University of Brescia, Brescia, Italy.
Jordan Giordani
Respiratory Medicine Unit, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Deborah Stassaldi
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Carlo Aggiusti
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Giuliana Martini
Hemostasis Central Laboratory, ASST Spedali Civili of Brescia, Brescia, Italy.
Giulia Arenare
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Internal Medicine, University of Brescia, Brescia, Italy.
Chantale Premoli
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Emergency Medicine, University of Brescia, Brescia, Italy.
Giulia Bosio
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Emergency Medicine, University of Brescia, Brescia, Italy.
Marco Lancelotti
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Emergency Medicine, University of Brescia, Brescia, Italy.
Francesca Bosisio
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Emergency Medicine, University of Brescia, Brescia, Italy.
Giorgia Muzi
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia; Post-graduate School of Emergency Medicine, University of Brescia, Brescia, Italy.
Maria Lorenza Muiesan
UOC 2a Medicina, Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.

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How to Cite

Pini, L., Malerba, P., Giordani, J., Stassaldi, D., Aggiusti, C., Martini, G., Arenare, G., Premoli, C., Bosio, G., Lancelotti, M., Bosisio, F., Muzi, G., & Muiesan, M. L. (2021). A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine. Emergency Care Journal, 17(4). https://doi.org/10.4081/ecj.2021.10032

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