"Abstract
Case description: CA young woman without any medical history presented association of deep vein thrombosis and thrombocytopenia at day 10 after vaccine injection... Twelve days post Ad26.COV2.S vaccination, the patient was admitted at our hospital for neurological deterioration and right hemiplegia. Medical imaging using MRI showed thrombosis of the major anterior part of the sagittal superior sinus with bilateral intraparenchymal hemorrhagic complications... Despite immediate treatment with intravenous immunoglobulin, dexamethasone, danaparoid and attempted neurosurgery the patient evolved toward brain death.
Introduction
Vaccine-induced thrombotic thrombocytopenia (VITT) also described as thrombosis with thrombocytopenia syndrome (TTS) has emerged as a very rare complication of adenovector-based immunization. VITT was initially described with the ChAdOx1 nCoV-19 vaccine (AstraZeneca) during its deployment in Europe. Recent reports from the US have highlighted the risk of VITT with the Ad26.COV2.S (Janssen, Johnson & Johnson)...
Discussion
... Up to May 25th 2021, The VITT cases observed with the ChAdOx1 nCoV-19 mainly involved young women. Current guidelines in the UK recommend administering the ChAdOx1 nCoV-19 in adults aged above 40 years old based on aged-based risk–benefit analysis. Following this first post-Ad26.COV2.S VITT case, Belgium recommended on May 26th the administration of Ad26.COV2.S only in adults aged above 41 years.
The identification of 6 VITT cases among 6.8 millions of doses in the US led to a temporary suspension of vaccination using Ad26.COV2.S on April 13th 2021...
The precise mechanisms of VITT are currently unknown. However, the fact that this rare complication is only observed with adenovirus-based COVID-19 vaccine points toward an abnormal immune response to the vector...
Conclusion
Physicians should maintain a high index of suspicion of VITT in patients who received an adenovirus-vector-based SARS-CoV-2 vaccine within the last 30 days with persistent complains [sic] compatible with VITT."
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2021
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