Institut Universitaire d'Anthropologie Médico-Légale, Faculté de Médecine, Université Côte d'Azur, 28 Avenue de Valombrose, 06107, Nice, France.
CEPAM (UMR CNRS 7264), 24 Avenue Des Diables Bleus, 06300, Nice, France.
Int J Legal Med. 2023 Mar;137(2):487-492. doi: 10.1007/s00414-022-02910-1. Epub 2022 Oct 27.
We report a case of cerebral venous sinus thrombosis, bilateral adrenal hemorrhage, and thrombocytopenia in a 70-year-old man found dead. He had previously received the ChAdOx1 nCoV-19 vaccine (Vaxzevria®, AstraZeneca) 18 days before, and had since developed unspecific and undiagnosed characteristics of what proved to be a rare case of vaccine-associated thrombocytopenia with thrombosis syndrome (TTS). He was found dead 1 week after the beginning of symptoms (day 25 post-vaccine). Autopsy yielded venous hemorrhagic infarction with the presence of thrombi within dural venous sinuses, and extensive hemorrhagic necrosis of the central part of the adrenal glands. Antibodies against platelet factor 4 (PF4) were strongly positive in postmortem fluids, as measured with an enzyme-linked immunosorbent assay (ELISA). This difficult diagnosis is usually made during the patient's lifetime. After eliminating differential diagnoses, we concluded on a fatal case of vaccine-induced immune TTS with positive anti-PF4 antibodies in cadaveric blood, 3 weeks after ChAdOx1 nCoV-19 vaccination. Specific search for anti-PF4 antibodies in cadaveric blood appears therefore paramount to assess postmortem cases of TTS associated with anti-COVID vaccines.
我们报告了一例 70 岁男性尸检病例，该患者因脑静脉窦血栓形成、双侧肾上腺出血和血小板减少而死亡。他在 18 天前接受了 ChAdOx1 nCoV-19 疫苗（Vaxzevria®，阿斯利康）接种，此后出现了无法明确诊断的特征，最终被证实为一种罕见的疫苗相关伴血小板减少和血栓形成综合征（TTS）病例。他在出现症状后 1 周（疫苗接种后第 25 天）死亡。尸检发现静脉出血性梗死，硬脑膜静脉窦内有血栓形成，肾上腺中央部分广泛出血性坏死。用酶联免疫吸附试验（ELISA）检测，尸检体液中抗血小板因子 4（PF4）抗体呈强阳性。这种困难的诊断通常是在患者生前做出的。在排除鉴别诊断后，我们得出结论，这是一例致命的疫苗诱导免疫性 TTS 病例，在 ChAdOx1 nCoV-19 疫苗接种后 3 周，尸检血液中存在抗 PF4 抗体。因此，在评估与抗 COVID 疫苗相关的 TTS 死后病例时，对尸检血液中抗 PF4 抗体的特异性检测至关重要。
