Department of Clinical Hematology, Farhat Hached University Hospital, Sousse, Tunisia.
Laboratory of Hematology, Sahloul University Hospital, Sousse, Tunisia.
J Med Case Rep. 2023 Mar 27;17(1):125. doi: 10.1186/s13256-023-03850-z.
In the literature, reported cases of Acquired hemophilia A (AHA) induced by COVID-19 vaccination occurred after Adenoviral Vector Deoxyribonucleic Acid (DNA)- and SARS-CoV-2 Messenger Ribonucleic acid (mRNA)-Based vaccines. Here, and to the best of our knowledge, we report the first case of AHA occurring after an inactivated Sinovac-coronavac COVID-19 vaccine.
A 69-year-old Tunisian male patient consulted for severe left leg pain limiting physical mobility due to a 5*6 cm large ecchymosis located at the left inner thigh, having spontaneously appeared 5 days prior consultation and without notion of trauma. The patient had no known personal medical history. He had received the second dose of CoronaVac-SinoVac vaccine 30 days prior to consultation. Further physical examination revealed the presence of two other ecchymoses: one at the inner face of the right forearm, starting at the wrist reaching the elbow and the other at the left flank of the abdomen. Diagnosis of AHA was based on clinical presentation and confirmed with prolonged a PTT, Factor VIII deficiency and the presence of an FVIII inhibitor. The patient was successfully treated with corticosteroids and low dose Rituximab.
Clinicians should consider AHA in front of prolonged aPTT with or without spontaneous bleedings even after inactivated virus COVID-19.
在文献中,COVID-19 疫苗接种后报告的获得性血友病 A(AHA)病例发生在腺病毒载体脱氧核糖核酸(DNA)和 SARS-CoV-2 信使核糖核酸(mRNA)疫苗之后。在这里,据我们所知,我们报告了首例在灭活的科兴中维冠状病毒病 COVID-19 疫苗接种后发生的 AHA 病例。
一名 69 岁的突尼斯男性患者因左腿严重疼痛就诊,左腿疼痛限制了身体的活动能力,因为左大腿内侧有一个 5*6 厘米大的瘀斑,该瘀斑在就诊前 5 天自发出现,且没有创伤的概念。患者没有已知的个人病史。他在就诊前 30 天接种了第二剂科兴中维新冠疫苗。进一步的体格检查发现还有另外两个瘀斑:一个在右前臂的内侧面,从手腕延伸到肘部,另一个在左腹部侧面。根据临床表现和延长的 PTT、VIII 因子缺乏和 FVIII 抑制剂的存在,诊断为 AHA。患者成功地接受了皮质类固醇和低剂量利妥昔单抗治疗。
即使在接种灭活病毒 COVID-19 疫苗后,出现延长的 aPTT 伴或不伴自发性出血时,临床医生也应考虑 AHA。