Ben Saida Imen, Maatouk Iyed, Toumi Radhouane, Bouslama Emna, Ben Ismail Hajer, Ben Salem Chaker, Boussarsar Mohamed
Medical Intensive Care Unit, Faculty of Medicine of Sousse, University of Sousse, Sousse 4000, Tunisia.
Research Laboratory Heart Failure, LR12SP09, Farhat Hached University Hospital, University of Sousse, Sousse 4000, Tunisia.
Vaccines (Basel). 2022 Jun 24;10(7):1012. doi: 10.3390/vaccines10071012.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in December 2019, causing millions of deaths all over the world, and the lack of specific treatment for severe forms of coronavirus disease 2019 (COVID-19) have led to the development of vaccines in record time, increasing the risk of vaccine safety issues. Recently, several cases of thrombotic thrombocytopenic purpura (TTP) have been reported following COVID-19 vaccination. TTP is a rare disease characterized by thrombocytopenia, microangiopathic hemolytic anemia and ischemic end-organ lesions. It can be either congenital or acquired. Various events such as viral infections, medication, pregnancy, malignancies, and vaccinations may cause TTP. Here, we report two cases of acquired TTP following Sinopharm COVID-19 vaccine (BBIBP-CorV) and Sinovac COVID-19 vaccine (CoronaVac). Diagnosis was based on clinical presentation and confirmed with a severe reduction in the activity of von Willebrand factor-cleaving protease ADAMTS-13 and the presence of inhibitory autoantibodies. The two patients were successfully treated with corticosteroids, plasma exchange therapy and rituximab in the acute phase. In the literature, the reported cases of TTP induced by COVID-19 vaccination occurred after Adenoviral Vector DNA- and SARS-CoV-2 mRNA-Based COVID-19 vaccines. To the best of our knowledge, this is the first report of acquired TTP after inactivated virus COVID-19 vaccination.
2019年12月爆发的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫情，导致全球数百万人死亡，且缺乏针对重症2019冠状病毒病（COVID-19）的特效治疗方法，促使疫苗在创纪录的时间内研发出来，这增加了疫苗安全问题的风险。最近，有几例接种COVID-19疫苗后出现血栓性血小板减少性紫癜（TTP）的病例报告。TTP是一种罕见疾病，其特征为血小板减少、微血管病性溶血性贫血和缺血性终末器官病变。它可以是先天性的，也可以是后天获得性的。病毒感染、药物、妊娠、恶性肿瘤和疫苗接种等各种事件都可能导致TTP。在此，我们报告两例接种国药集团COVID-19疫苗（BBIBP-CorV）和科兴COVID-19疫苗（CoronaVac）后出现的后天获得性TTP病例。诊断基于临床表现，并通过血管性血友病因子裂解蛋白酶ADAMTS-13活性严重降低以及存在抑制性自身抗体得以证实。两名患者在急性期成功接受了皮质类固醇、血浆置换疗法和利妥昔单抗治疗。在文献中，报道的由COVID-19疫苗诱导的TTP病例发生在腺病毒载体DNA和基于SARS-CoV-2 mRNA的COVID-19疫苗接种之后。据我们所知，这是首次报告灭活病毒COVID-19疫苗接种后出现后天获得性TTP的病例。
