A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins. In a time where there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalisation, this particular clinical scenario emphasises the need of all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.
- portal vein
- immunological products and vaccines
- pulmonary embolism
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Contributors The case was diagnosed and managed by gastroenterology and acute medial team, with JP and HA being the consultants and HA and FF being the registrars for the respective teams. HAs: she designed and wrote first draft of the manuscript including summary, introduction, case and discussion. She also complied the table of results and treatment and edited the manuscript as per her supervisor (JP) guidance and added images. Moreover, she spoke to the patient and took her personal statement and got her consent. She is also responsible for submitting the report to the BMJ. JP pointed out the case to be reported and supervised each step. He did critical revision of the manuscript, edited and approved the final version. He also provided the images by liaising with the radiologist. FF: he contributed to manuscript writing. HAl: he supervised and contributed to editing the manuscript and approved the final approval. All four authors approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.