Vaccine-induced severe thrombotic thrombocytopenia following COVID-19 vaccination: a report of an autoptic case and review of the literature

被引:37
|
作者
Fanni, D. [1 ]
Saba, L. [2 ]
Demontis, R. [3 ]
Gerosa, C. [1 ]
Chighine, A. [3 ]
Nioi, M. [3 ]
Suri, J. S. [4 ]
Ravarino, A. [1 ]
Cau, F. [5 ]
Barcellona, D. [6 ]
Botta, M. C. [5 ]
Porcu, M. [2 ]
Scano, A. [7 ]
Coghe, F. [8 ]
Orru, G. [7 ]
Van Eyken, P. [9 ]
Gibo, Y. [10 ]
La Nasa, G. [11 ]
D'Aloja, E. [3 ]
Marongiu, F. [6 ]
Faa, G. [1 ,12 ]
机构
[1] Univ Cagliari, Dept Med Sci & Publ Hlth, Div Pathol, Cagliari, Italy
[2] Univ Cagliari, Dept Radiol, Cagliari, Italy
[3] Univ Cagliari, Dept Med Sci & Publ Hlth, Div Legal Med, Cagliari, Italy
[4] AtheroPoint, Monitoring & Diagnost Div, Roseville, CA USA
[5] ATS, Div Pathol, San Gavino Hosp, San Gavino, Italy
[6] Univ Cagliari, Dept Med Sci & Publ Hlth, Cagliari, Italy
[7] Univ Cagliari, Dept Med Sci & Publ Hlth, Mol Biol Serv MBS, Cagliari, Italy
[8] Univ Cagliari, Dept Med Sci & Publ Hlth, Lab Clin Chem Anal & Microbiol, Cagliari, Italy
[9] UZ Genk Reg Hosp, Dept Pathol, Genk, Belgium
[10] Hepatol Clin, Matsumoto, Nagano, Japan
[11] Univ Cagliari, Businco Hosp ARNAS Brotzu, Dept Med Sci & Publ Hlth, Hematol, Cagliari, Italy
[12] Temple Univ, Dept Biol, Coll Sci & Technol, Philadelphia, PA 19122 USA
关键词
VITT; COVID-19; Thrombotic thrombocytopenia; vaccination; DISSEMINATED INTRAVASCULAR COAGULATION;
D O I
10.26355/eurrev_202108_26464
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
OBJECTIVE: Vaccine-induced immune thrombocytopenia ( VITT) is a new syndrome occurring primarily in healthy young adults, with a female predominance, after receiving the first dose of ChAdOx1 nCoV-19 vaccine. We describe VITT syndrome characterized by severe thrombosis and thrombocytopenia found in our patient, with fatal outcome. CASE REPORT: A 5 8-year-old man, after 13 days from the first administration of ChAdOx1 nCoV-19 vaccine (AstraZeneca), presented with abdominal pain, diarrhea and vomitus. Laboratory tests revealed a severe thrombocytopenia, low fibrinogen serum levels and marked increase of D-dimer serum levels. The patient quickly developed a multiple organ failure, till death, three days after the hospital admission. RESULTS: At histology, in the lungs, interalveolar septa appeared thickened with microthrombi in the capillaries and veins. Interalveolar septa appeared thickened and showed vascular proliferation. Thrombi were detected in the capillaries of glomerular tufts. In the hearth, thrombi were observed in veins and capillaries. In the liver, voluminous fibrin thrombi were diffusely observed in the branches of the portal vein. Microthrombi were also found in the vasa vasorum of the wall of abdominal aorta. In the brain, microthrombi were observed in the capillaries of the choroid plexuses. Diffuse hemorrhagic necrosis was observed in the intestinal wall with marked congestion of the venous vessels. CONCLUSIONS: In our patient, the majority of data necessary for a VITT final diagnosis were present: thrombocytopenia and thrombosis in pulmonary, portal, hepatic, renal and mesenteric veins, associated with a marked increase of D-dimer serum levels. The finding of cerebral thrombosis in choroid plexuses, is a new finding in VITT. These features are suggestive for a very aggressive form of VITT.
引用
收藏
页码:5063 / 5069
页数:7
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