Thrombotic thrombocytopenic purpura following ChAdOx1 nCov-19 vaccination: A case report
Bahareh Shateri Amiri,
Hanieh Radkhah,
Reza Taslimi,
Zahra Shahbazi Dastjerdi,
Mohamad Mehdi Khadembashiri,
Milad Gholizadeh Mesgarha,
Shiva Rahimipour Anaraki
Affiliations
Bahareh Shateri Amiri
Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Iran
Hanieh Radkhah
Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; Correspondence to: Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Imam Khomeini St., Hassan Abad Sq., Sina Hospital, 1136746911 Tehran, Iran.
Reza Taslimi
Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Zahra Shahbazi Dastjerdi
Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mohamad Mehdi Khadembashiri
Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
Milad Gholizadeh Mesgarha
Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
Shiva Rahimipour Anaraki
Faculty of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
Vaccine-associated thrombotic thrombocytopenic purpura (TTP) is a rare type of acquired TTP recently reported after COVID-19 vaccination. Merely four cases are ascribed to the ChAdOx1 nCoV-19 vaccine in the medical literature till the preparation of this study. In this case report, we describe a 43-year-old man who developed symptoms of TTP four days after receiving the second dose of the ChAdOx1 nCoV-19 vaccine. Peripheral blood smear demonstrated multiple schistocytes. Given a high plasmic score, he received plasma exchange, corticosteroids, and rituximab, and later, low ADAMTS 13 activity and high-titer ADAMTS inhibition antibody confirmed the diagnosis of COVID-19 vaccine-associated TTP. COVID-19 vaccine-associated TTP is an infrequent consequence of SARS-CoV-2 vaccination but with a substantial mortality rate which must be considered as one of the crucial differential diagnoses of post-COVID-19 vaccine thrombocytopenia besides vaccine-induced immune thrombotic thrombocytopenia and Immune thrombocytopenic purpura.
