Kadam Nikhil, Ramavathu Kumar Vm, Kamath Namita, Min Kaung Kyaw
Internal Medicine Trainee, Southend University Hospital, Mid and South Essex NHS Trust, Southend-on-Sea, United Kingdom.
Southend University Hospital, Mid and South Essex NHS Trust, Southend-on-Sea, United Kingdom.
BJR Case Rep. 2021 Oct 6;8(1):20210138. doi: 10.1259/bjrcr.20210138. eCollection 2022 Jan 1.
Covid-19 vaccine was developed in response to the SARS Cov2 pandemic. Despite the effectiveness of the vaccine, various complications have been reported after vaccination. We present the case of a 55-year-old patient with post-vaccination complication. The patient was vaccinated with ChAdOx1 nCov-19 Vaccine and 2 weeks later presented with headache, confusion and abdominal pain for 1 week duration. Clinical examination demonstrated reduced Glasgow Coma Scale (GCS), reduced muscle power bilaterally and dysphasia. Blood test showed thrombocytopenia, high titres of D-Dimer and mildly raised INR. The CT scan of the head showed a fairly large left temporoparietal intracranial hemorrhage with midline shift and subsequent CT venogram demonstratedthrombosis of the left transverse and sigmoid dural venous sinuses. CT scan of the abdomen and pelvis showed thrombosis of the portal and hepatic veins and multiple infarcts of the liver, left kidney and lingular segment of the partially imaged lungs (Figure 2). Patient tested positive for antibodies directed against platelet factor-4 and was treated for vaccine induced thrombotic thrombocytopenia. Treatment included Intravenous immunoglobulin, Fresh Frozen Plasma, non-heparin based anticoagulant and required care in tertiary center. Incidence of vaccine-induced immune thrombotic thrombocytopenia is unknown and strongly mimics autoimmune heparin-induced thrombocytopenia with typical clinical features of thrombocytopenia and thrombosis. Of the reported cases, the common imaging finding is thrombosis in various sites such as cerebral venous thrombosis, portal vein thrombosis, pulmonary embolism and ischemic stroke.
新冠疫苗是针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行而研发的。尽管疫苗有效，但接种后已报告了各种并发症。我们报告一例55岁接种疫苗后出现并发症的患者。该患者接种了ChAdOx1 nCov-19疫苗，2周后出现头痛、意识模糊和腹痛，持续1周。临床检查显示格拉斯哥昏迷量表（GCS）评分降低、双侧肌力减弱和言语困难。血液检查显示血小板减少、D-二聚体高滴度和国际标准化比值（INR）轻度升高。头部CT扫描显示左侧颞顶叶有相当大的颅内出血并伴有中线移位，随后的CT静脉造影显示左侧横窦和乙状窦硬脑膜静脉窦血栓形成。腹部和骨盆CT扫描显示门静脉和肝静脉血栓形成以及肝脏、左肾和部分成像肺部舌段的多处梗死（图2）。患者针对血小板因子4的抗体检测呈阳性，并接受了疫苗诱导的血栓性血小板减少症的治疗。治疗包括静脉注射免疫球蛋白、新鲜冰冻血浆、非肝素类抗凝剂，并需要在三级中心进行护理。疫苗诱导的免疫性血栓性血小板减少症的发病率尚不清楚，且强烈模仿自身免疫性肝素诱导的血小板减少症，具有血小板减少和血栓形成的典型临床特征。在已报告的病例中，常见的影像学表现是不同部位的血栓形成，如脑静脉血栓形成、门静脉血栓形成、肺栓塞和缺血性中风。
