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Case Reports
. 2021 Aug;19(8):2014-2018.
doi: 10.1111/jth.15418. Epub 2021 Jul 5.

First report of a de novo iTTP episode associated with an mRNA-based anti-COVID-19 vaccination

Sévérine de Bruijn  1 , Marie-Berthe Maes  2 , Laure De Waele  3 , Karen Vanhoorelbeke  3 , Alain Gadisseur  1   4
Affiliations
Case Reports

First report of a de novo iTTP episode associated with an mRNA-based anti-COVID-19 vaccination

Sévérine de Bruijn et al. J Thromb Haemost. 2021 Aug.

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening thrombotic microangiopathy, characterized by disseminated thrombus formation in the microvasculature, causing severe organ failure. Immune-mediated TTP (iTTP) is occasionally described after vaccination, especially against viral agents. We report a case of a 38-year-old woman with a de novo iTTP after exposure to the mRNA-based anti-coronavirus disease 2019 (COVID-19) vaccine produced by Pfizer-BioNTech. She presented with increased bruising and petechiae starting 2 weeks after receiving the first dose of the anti-COVID-19 vaccine. Laboratory data revealed a severe ADAMTS13-deficiency in combination with a very high autoantibody titer against ADAMTS13. She was successfully treated with plasma exchange, corticosteroids, rituximab, and caplacizumab. To our knowledge, this is the first case report of iTTP after mRNA-based COVID-19 vaccination in a previously TTP-naïve patient.

Keywords: COVID-19; corticosteroids; plasmapheresis; purpura; thrombotic thrombocytopenic; vaccination.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Evolution platelet count (×109/L), LDH level (U/L), ADAMTS13 inhibitor level (BU), and ADAMTS13 enzyme activity (IU/ml) starting from day of vaccination and throughout the hospitalization period (d1 = day of admission).
See this image and copyright information in PMC

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