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

Submitted: 12 August 2021
Accepted: 9 November 2021
Published: 20 December 2021
Abstract Views: 908
PDF: 326
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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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Citations

Sabeerabi B, Vemula S, Vadde R, Nagaraju GP. COVID-19: Where is the treatment? World J Clin Oncol 2021;12:309-22. DOI: https://doi.org/10.5306/wjco.v12.i5.309
Orzes N, Pini L, Levi G, et al. A prospective evaluation of lung function at three and six months in patients with previous SARS-COV-2 pneumonia. Resp Med 2021;106541 DOI: https://doi.org/10.1016/j.rmed.2021.106541
Quek E, Tahir H, Kumar P, et al. Treatment of COVID-19: a review of current and prospective pharmacotherapies. Br J Hosp Med (Lond) 2021;82:1-9. DOI: https://doi.org/10.12968/hmed.2021.0112
Heustess AM, Allard MA, Thompson DK, Fasinu PS. Clinical management of COVID-19: A review of pharmacological treatment options. Pharmaceuticals (Basel) 2021;14:520. DOI: https://doi.org/10.3390/ph14060520
Sharma O, Sultan AA, Ding H, Triggle CR. A review of the progress and challenges of developing a vaccine for COVID-19. Front Immunol 2020;11:585354. DOI: https://doi.org/10.3389/fimmu.2020.585354
Rzymski P, Perek B, Flisiak R. Thrombotic thrombocytopenia after COVID-19 vaccination: In search of the underlying mechanism. Vaccines (Basel) 2021;9:559. DOI: https://doi.org/10.3390/vaccines9060559
Doroftei B, Ciobica A, Ilie OD, et al. Mini-Review Discussing the Reliability and Efficiency of COVID-19 Vaccines. Diagnostics (Basel) 2021;11:579. DOI: https://doi.org/10.3390/diagnostics11040579
Long B, Bridwell R, Gottlieb M. Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines. Am J Emerg Med 2021;49:58-61. DOI: https://doi.org/10.1016/j.ajem.2021.05.054
Lavin M, Elder PT, O’Keeffe D, et al. Vaccine-induced immune thrombotic thrombocytopenia (VITT) - a novel clinico-pathological entity with heterogeneous clinical presentations. Br J Haematol 2021;195:76-84. DOI: https://doi.org/10.1111/bjh.17613
Oldenburg J, Klamroth R, Langer F, et al. Diagnosis and management of vaccine-related thrombosis following AstraZeneca COVID-19 vaccination: Guidance statement from the GTH. Hamostaseologie 2021;41:184-9. DOI: https://doi.org/10.1055/s-0041-1729135
Gras-Champel V, Liabeuf S, Baud M, et al. Atypical thrombosis associated with VaxZevria® (AstraZeneca) vaccine: Data from the French Network of Regional Pharmacovigilance Centres. Therapie 2021:S0040-5957(21)00130-X.
Pottegård A, Lund LC, Karlstad Ø, et al. Arterial events, venous thromboembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort study. BMJ 2021;373:n1114. DOI: https://doi.org/10.1136/bmj.n1114
ISTH Interim Guidance for the Diagnosis and Treatment on VaccineInduced Immune Thrombotic Thrombocytopenia. Available from: https://www.isth.org/page/covid19
Gresele P, Marietta M, Ageno W, et al. Management of cerebral and splanchnic vein thrombosis associated with thrombocytopenia in subjects previously vaccinated with Vaxzevria (AstraZeneca): a position statement from the Italian Society for the Study of Haemostasis and Thrombosis (SISET). Blood Transfus 2021;19:281-3.
Franchini M, Liumbruno GM, Pezzo M. COVID-19 vaccine-associated immune thrombosis and thrombocytopenia (VITT): Diagnostic and therapeutic recommendations for a new syndrome. Eur J Haematol 2021;107:173–80. DOI: https://doi.org/10.1111/ejh.13665
Karnam A, Lacroix-Desmazes S, Kaveri SV, Bayry J. Vaccine-induced prothrombotic immune thrombocytopenia (VIPIT): Consider IVIG batch in the treatment. J Thromb Haemost 2021;19:1838-9. DOI: https://doi.org/10.1111/jth.15361
Hunter PR. Thrombosis after covid-19 vaccination. BMJ 2021;373:n958. DOI: https://doi.org/10.1136/bmj.n958
Scully M, Singh D, Lown R, et al. Pathologic antibodies to platelet factor 4 after ChAdOx1 nCoV-19 vaccination. N Engl J Med 2021;384:2202-11. DOI: https://doi.org/10.1056/NEJMoa2105385
Douxfils J, Favresse J, Dogné JM, et al. Hypotheses behind the very rare cases of thrombosis with thrombocytopenia syndrome after SARS-CoV-2 vaccination. Thromb Res 2021;203:163-71. DOI: https://doi.org/10.1016/j.thromres.2021.05.010
Patriquin CJ, Laroche V, Selby R, et al. Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med 26;385:857-9. DOI: https://doi.org/10.1056/NEJMc2109465

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