Yaghoubi Fatemeh, Dalil Davood
Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Medical Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran.
Caspian J Intern Med. 2022;13(Suppl 3):299-302. doi: 10.22088/cjim.13.0.299.
Rare cases of acquired thrombotic thrombocytopenic purpura (aTTP) have been reported since the administration of the COVID-19 vaccination. Based on our information, the present study provides the first case report of aTTP developed after the COVID-19 vaccination in Iran.
A 22-year-old Iranian woman presented with symptoms of ataxia, dysphasia, paresthesia, and acute numbness of her left upper limb four weeks after the AstraZeneca COVID-19 vaccination. Laboratory data suggested hemolytic anemia and thrombocytopenia. Also, schistocytes were noted on her peripheral blood smear. Acquired thrombotic thrombocytopenic purpura (aTTP) was diagnosed in accordance with clinical manifestations along with initial blood test results and was confirmed later through findings of ADAMTS-13 low level activity and the ADAMTS-13 positive inhibitor. She underwent 22 sessions of plasma exchange, receiving corticosteroid and rituximab. Finally, the treatment was successful.
Despite the presence of rare complications such as aTTP, vaccination is one of the best ways to prevent COVID-19 disease. The present case report describes the potential, but unproven, role of the AstraZeneca COVID-19 vaccine in aTTP pathogenesis. Vaccine-associated aTTP can be successfully treated with plasma exchange, corticosteroids, and rituximab.
自接种新冠疫苗以来，已有罕见的获得性血栓性血小板减少性紫癜（aTTP）病例报告。据我们所知，本研究提供了伊朗首例接种新冠疫苗后发生aTTP的病例报告。
一名22岁的伊朗女性在接种阿斯利康新冠疫苗四周后，出现共济失调、言语困难、感觉异常和左上肢急性麻木症状。实验室数据提示溶血性贫血和血小板减少。此外，其外周血涂片可见破碎红细胞。根据临床表现及初始血液检查结果诊断为获得性血栓性血小板减少性紫癜（aTTP），随后通过ADAMTS-13低水平活性及ADAMTS-13阳性抑制剂的检查结果得以确诊。她接受了22次血浆置换，并接受了皮质类固醇和利妥昔单抗治疗。最终，治疗取得成功。
尽管存在aTTP等罕见并发症，但接种疫苗仍是预防新冠疾病的最佳方法之一。本病例报告描述了阿斯利康新冠疫苗在aTTP发病机制中潜在但未经证实的作用。疫苗相关的aTTP可通过血浆置换、皮质类固醇和利妥昔单抗成功治疗。
