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Intracerebral Hemorrhage due to Thrombosis with Thrombocytopenia Syndrome after Vaccination against COVID-19: the First Fatal Case in Korea.
J Korean Med Sci. 2021 Aug 09; 36(31):e223.JK

Abstract

Vaccination with an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in the rare development of thrombosis with thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4). This is a life-threating condition that may be accompanied by bleeding due to thrombocytopenia with thrombosis of the cerebral venous sinus or splanchnic vein. Herein, we describe the first fatal case of thrombosis with thrombocytopenia syndrome in Korea, presenting with intracranial hemorrhage caused by cerebral venous sinus thrombosis. A 33-year-old Korean man received the first dose of the ChAdOx1 nCoV-19 vaccination. He developed severe headache with vomiting 9 days after the vaccination. Twelve days after vaccination, he was admitted to the hospital with neurological symptoms and was diagnosed with cerebral venous sinus thrombosis, which was accompanied by intracranial hemorrhage. Thrombocytopenia and D-dimer elevation were observed, and the result of the PF4 enzyme-linked immunosorbent assay antibody test was reported to be strongly positive. Despite intensive treatment, including intravenous immunoglobulin injection and endovascular mechanical thrombectomy, the patient died 19 days after vaccination. Physicians need to be aware of thrombosis with thrombocytopenia syndrome (TTS) in adenoviral vector-vaccinated patients. Endovascular mechanical thrombectomy might be a useful therapeutic option for the treatment of TTS with cerebral venous sinus thrombosis.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Division of Hematology/Oncology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Division of Infectious Diseases, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. operatua@gmail.com.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

34402235

Citation

Choi, Jae Ki, et al. "Intracerebral Hemorrhage Due to Thrombosis With Thrombocytopenia Syndrome After Vaccination Against COVID-19: the First Fatal Case in Korea." Journal of Korean Medical Science, vol. 36, no. 31, 2021, pp. e223.
Choi JK, Kim S, Kim SR, et al. Intracerebral Hemorrhage due to Thrombosis with Thrombocytopenia Syndrome after Vaccination against COVID-19: the First Fatal Case in Korea. J Korean Med Sci. 2021;36(31):e223.
Choi, J. K., Kim, S., Kim, S. R., Jin, J. Y., Choi, S. W., Kim, H., Yoo, J. H., Park, I. S., & Kim, S. R. (2021). Intracerebral Hemorrhage due to Thrombosis with Thrombocytopenia Syndrome after Vaccination against COVID-19: the First Fatal Case in Korea. Journal of Korean Medical Science, 36(31), e223. https://doi.org/10.3346/jkms.2021.36.e223
Choi JK, et al. Intracerebral Hemorrhage Due to Thrombosis With Thrombocytopenia Syndrome After Vaccination Against COVID-19: the First Fatal Case in Korea. J Korean Med Sci. 2021 Aug 9;36(31):e223. PubMed PMID: 34402235.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intracerebral Hemorrhage due to Thrombosis with Thrombocytopenia Syndrome after Vaccination against COVID-19: the First Fatal Case in Korea. AU - Choi,Jae Ki, AU - Kim,Sunghan, AU - Kim,Seo Ree, AU - Jin,Jong Youl, AU - Choi,Seon Woong, AU - Kim,Hoon, AU - Yoo,Jin Hong, AU - Park,Ik Seong, AU - Kim,Seong Rim, Y1 - 2021/08/09/ PY - 2021/07/16/received PY - 2021/07/28/accepted PY - 2021/8/17/entrez PY - 2021/8/18/pubmed PY - 2021/8/26/medline KW - COVID-19 Vaccines KW - Endovascular Procedures KW - Intracranial Sinus Thrombosis KW - Mechanical Thrombolysis KW - Platelet Factor 4 SP - e223 EP - e223 JF - Journal of Korean medical science JO - J Korean Med Sci VL - 36 IS - 31 N2 - Vaccination with an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in the rare development of thrombosis with thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4). This is a life-threating condition that may be accompanied by bleeding due to thrombocytopenia with thrombosis of the cerebral venous sinus or splanchnic vein. Herein, we describe the first fatal case of thrombosis with thrombocytopenia syndrome in Korea, presenting with intracranial hemorrhage caused by cerebral venous sinus thrombosis. A 33-year-old Korean man received the first dose of the ChAdOx1 nCoV-19 vaccination. He developed severe headache with vomiting 9 days after the vaccination. Twelve days after vaccination, he was admitted to the hospital with neurological symptoms and was diagnosed with cerebral venous sinus thrombosis, which was accompanied by intracranial hemorrhage. Thrombocytopenia and D-dimer elevation were observed, and the result of the PF4 enzyme-linked immunosorbent assay antibody test was reported to be strongly positive. Despite intensive treatment, including intravenous immunoglobulin injection and endovascular mechanical thrombectomy, the patient died 19 days after vaccination. Physicians need to be aware of thrombosis with thrombocytopenia syndrome (TTS) in adenoviral vector-vaccinated patients. Endovascular mechanical thrombectomy might be a useful therapeutic option for the treatment of TTS with cerebral venous sinus thrombosis. SN - 1598-6357 UR - https://www.unboundmedicine.com/medline/citation/34402235/Intracerebral_Hemorrhage_due_to_Thrombosis_with_Thrombocytopenia_Syndrome_after_Vaccination_against_COVID_19:_the_First_Fatal_Case_in_Korea_ DB - PRIME DP - Unbound Medicine ER -