"Abstract
We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs... Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination...
Discussion
... The histological findings in our case suggest the presence of vascular endothelial damage and platelet thrombosis, which was similar to microvascular injuries that can occur after COVID-19...
We hypothesize that the rhabdomyolysis was induced by the mRNA-1273 vaccination because our patient did not have any other trigger for rhabdomyolysis such as viral infection, medications, trauma, alcohol abuse, malignancies, or specific autoantibodies...
It is possible that the spike antigen of SARS-CoV-2 binds to platelets and cooperates with aPL [antiphospholipid antibodies] to activate inflammatory cytokines, coagulation factors, and complement cascades. In our case, exposure to the SARS-CoV-2 spike antigen (mRNA-1273 vaccination) is likely to have promoted LA [lupus anticoagulant] production."
Copyright: © 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
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