Venous sinus thrombosis after the first dose of Pfizer BioNTech vaccine
Tóm tắt
mRNA vaccines including Pfizer BioNTech and Moderna have categorically been considered safe when it comes to preventing COVID-19. However, there is still a small associated risk of thromboembolic phenomenon including venous sinus thrombosis with it and our case report highlights one.
We describe a patient who developed severe progressive headache, tinnitus and visual disturbance symptoms post-Pfizer-SARS-CoV-2 vaccination. His medical history included essential tremors, hypertension, type 2 diabetes mellitus, chronic kidney disease stage 3, anxiety, depression and long-term catheterisation. Systemic examination revealed hypotonia, generalised reduced power and central diplopia along with peripheral visual field defect in the left eye. He was extensively investigated, the COVID-19 PCR test was negative and all routine blood tests were in the normal range except a marginally raised D-dimer of 779 ng/mL. CT head was unremarkable. He was also tested for myasthenia gravis; however, acetylcholine receptors antibodies were negative and nerve conduction studies were normal. Subsequent MRI of the brain with venography confirmed venous sinus thrombosis. A 24-hour Holter monitoring test did not reveal any cardiac rate or rhythm abnormality. He was treated with apixaban as per a neurologist’s advice. His clinical condition started to improve and was later discharged from the hospital with an outpatient neurologist clinic follow-up.
Từ khóa
Tài liệu tham khảo
HAN Archive - 00442 [Internet]. Cdc.gov, 2021. Available: https://emergency.cdc.gov/han/2021/han00442.asp [Accessed 16 Oct 2021].
Greinacher, 2021, Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination, N Engl J Med Overseas Ed, 384, 2092, 10.1056/NEJMoa2104840
Schultz, 2021, Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination, N Engl J Med, 384, 2124, 10.1056/NEJMoa2104882
Muir, 2021, Thrombotic thrombocytopenia after Ad26.COV2.S vaccination, N Engl J Med, 384, 1964, 10.1056/NEJMc2105869
See, 2021, US case reports of cerebral venous sinus Thrombosis with thrombocytopenia after Ad26.COV2.S vaccination, March 2 to April 21, 2021, JAMA, 325, 2448, 10.1001/jama.2021.7517
Thrombosis with thrombocytopenia syndrome - hematology.Org [Internet]. Hematology.org:443. Available: https://www.hematology.org:443/covid-19/vaccine-induced-immune-thrombotic-thrombocytopenia [Accessed 16 Oct 2021].
Yu, 2020, Direct activation of the alternative complement pathway by SARS-CoV-2 spike proteins is blocked by factor D inhibition, Blood, 136, 2080, 10.1182/blood.2020008248
Talotta, 2021, Do COVID-19 RNA-based vaccines put at risk of immune-mediated diseases? In reply to "potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases", Clin Immunol, 224, 10.1016/j.clim.2021.108665
Taquet M . Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases [Internet]. Open Science Framework, 2021. Available: https://osf.io/h2mt7/ [Accessed 16 Oct 2021].
Pawlowski C , Rincón-Hekking J , Awasthi S . Cerebral venous sinus thrombosis (CVST) is not significantly linked to COVID-19 vaccines or non-COVID vaccines in a large multi-state US health system. bioRxiv 2021.