Department of Rheumatology and Immunology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Guangdong, China.
Front Immunol. 2022 Apr 25;13:851316. doi: 10.3389/fimmu.2022.851316. eCollection 2022.
For patients with autoimmune diseases, vaccination is controversial. The use of vaccination in patients with autoimmune diseases is controversial. There are many reports of secondary thrombotic thrombocytopenic purpura cases after various vaccinations. Thrombotic thrombocytopenic purpura is a rare thrombotic microangiopathy characterized by microvascular pathological hemolytic anemia, severe thrombocytopenia, and ischemic organ damage with a very high fatality rate. We report a case of thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus after rabies vaccination. She developed gastrointestinal bleeding nearly a month after the vaccination. Laboratory tests confirmed a severe deficiency of ADAMTS13 and the presence of ADAMTS13 autoantibodies. Through early identification of thrombotic thrombocytopenic purpura, immunosuppressive therapy, and plasma exchange treatment, the patient was saved from danger. This case suggests that attenuated vaccines may also have unexpected adverse effects in patients with long-term use of immunosuppressive drugs and autoimmune diseases. To our knowledge, this is the first case report of thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus secondary to rabies vaccination.
对于患有自身免疫性疾病的患者，疫苗接种存在争议。自身免疫性疾病患者使用疫苗存在争议。有许多关于各种疫苗接种后发生继发性血栓性血小板减少性紫癜病例的报道。血栓性血小板减少性紫癜是一种罕见的血栓性微血管病，其特征为微血管病理性溶血性贫血、严重血小板减少症和伴有极高死亡率的缺血性器官损害。我们报告了一例系统性红斑狼疮患者在接种狂犬病疫苗后发生血栓性血小板减少性紫癜。她在接种疫苗近一个月后出现胃肠道出血。实验室检查证实 ADAMTS13 严重缺乏，且存在 ADAMTS13 自身抗体。通过早期识别血栓性血小板减少性紫癜、免疫抑制治疗和血浆置换治疗，患者脱离了危险。该病例提示，减毒疫苗在长期使用免疫抑制剂和自身免疫性疾病的患者中也可能产生意想不到的不良反应。据我们所知，这是首例系统性红斑狼疮继发于狂犬病疫苗接种的血栓性血小板减少性紫癜病例报告。
