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Case Reports: Adverse drug reactions and complications
Severe case of refractory immune thrombocytopenic purpura requiring splenectomy after the COVID-19 vaccine
  1. Sarina Koilpillai1,
  2. Bianca Dominguez1,
  3. Azeem Khan2 and
  4. Steve Carlan3
  1. 1Internal Medicine, Orlando Regional Healthcare, Orlando, Florida, USA
  2. 2Pathology, Orlando Regional Healthcare, Orlando, Florida, USA
  3. 3Department of Obstetrics and Gynecology, Orlando Health Corp, Orlando, Florida, USA
  1. Correspondence to Dr Steve Carlan; stevecarlan{at}gmail.com

Abstract

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder caused by autoantibodies against platelet antigens resulting in platelet destruction and inhibition of platelet production. Occasionally, an inciting event such as a virus or vaccination can precipitate ITP. Several cases of ITP have been reported after the BTN162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) SARS-CoV-2 (COVID-19) vaccines. All reported cases of post-vaccination ITP have resolved with medical therapy until this case.

A man in his mid-20s developed bleeding from ITP 2 weeks after receiving the second dose of the Pfizer SARS-CoV-2 vaccine. All inpatient medical treatment attempts failed. On hospital day 40, a splenectomy was performed and he ultimately recovered and was discharged.

Awareness of potential vaccination side effects is a fundamental element of refining and improving patient safety. This case illustrates that given the right circumstances, serious refractory ITP can develop in response to the second dose of the Pfizer SARS-CoV-2 vaccine.

  • COVID-19
  • Haematology (drugs and medicines)

https://doi.org/10.1136/bcr-2022-250153

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    Footnotes

    • Contributors Writing the initial draft of the manuscript—SK, BD, SC and AK. Conceptualisation and supervision—SK and BD. Medical management of the case—SK and BD. Revising the manuscript critically and literature review—SK, BD, SC and AK.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.