"A 78-year-old woman with no personal or family history of abnormal bleeding noticed a bruise on her thigh 2 weeks after her second COVID-19 (SARS-CoV-2) mRNA vaccination (Pfizer-BioNTech... ). Otherwise, she had no serious adverse events following vaccination. Her skin bruise persisted. On day 38, a new skin bruise appeared on her left hand. On day 50, she visited a hospital because of pain and swelling in the left hand. She had no evidence of any malignancies or autoimmune disorders and no medication intake. Her SARS-CoV-2 antigen was negative. The hematoma was removed to treat her compartment syndrome of the left hand. However, she had persistent postoperative bleeding and red blood cell units were transfused (2 units/day for 3 days). On day 55, she was transferred to [the] hematology department...
Various autoimmune diseases have been reported to develop after SARS‐CoV‐2 mRNA vaccination. To date, seven cases of autoimmune F8 deficiency (AiF8D; or acquired hemophilia A), which is the most frequent AiCFD, have been reported. On the contrary, AiF13D is an extremely rare AiCFD, and this is the world's first case of AiF13D that is likely to have been triggered by SARS-CoV-2 mRNA vaccination. The exact mechanism(s) responsible for these immuno-hematological complications is unknown, but the onset time of our case is similar to other immune-related adverse events such as nephritis, vasculitis, etc. following vaccination...
Administration of F13 concentrates (1200 units/day for 5 days) significantly improved her symptoms, and she was discharged home on day 74... [W]e made a definite diagnosis of autoimmune F13 deficiency (AiF13D), according to the ISTH/SSC criterion 2015. Immediately, prednisolone (0.5 mg/kg daily) was administered orally on day 91, but she noticed a new bruise on her right hand on day 100 ... However, she was found lying on the floor in the early morning on day 109 ... [S]he died of CNS bleeding (i.e., cerebral hemorrhage and subarachnoid hemorrhage) in the afternoon on the same day after approximately 10 h...
There were no clear reasons or triggers for neither the first CNS bleeding episode on day 55 nor the second episode on day 109 in [the] patient."
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