Acquired Thrombotic Thrombocytopenic Purpura Following BNT162b2 mRNA Coronavirus Disease Vaccination in a Japanese Patient

Kikuaki Yoshida; Ayaka Sakaki; Yoriko Matsuyama; Toshiki Mushino; Masanori Matsumoto; Takashi Sonoki; Shinobu Tamura

doi:10.2169/internalmedicine.8568-21

This article has now been updated. Please use the final version.

Acquired Thrombotic Thrombocytopenic Purpura Following BNT162b2 mRNA Coronavirus Disease Vaccination in a Japanese Patient

Kikuaki Yoshida, Ayaka Sakaki, Yoriko Matsuyama, Toshiki Mushino, Masanori Matsumoto, Takashi Sonoki, Shinobu Tamura

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Keywords: acquired thrombotic thrombocytopenic purpura, Covid-19, BNT162b2 mRNA vaccine, plasma exchange

JOURNAL OPEN ACCESS Advance online publication

Article ID: 8568-21

DOI https://doi.org/10.2169/internalmedicine.8568-21

The final version of this article is now available: Vol. 61 (2022), No. 3 pp. 407-412

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Abstract

A 57-year-old man without underlying diseases presented with fatigue, loss of appetite, and jaundice 1 week after receiving the first dose of the BNT162b2 mRNA coronavirus disease (COVID-19) vaccine and showed hemolytic anemia with fragmented erythrocytes and severe thrombocytopenia 2 weeks after receiving the vaccine. An ADAMTS13 activity level of <10% and ADAMTS13 inhibitor positivity confirmed the diagnosis of acquired thrombotic thrombocytopenic purpura (TTP). Combination therapy with plasma exchange, corticosteroid, and rituximab improved the clinical outcome. We herein report the first Japanese case of TTP possibly associated with vaccination. Physicians should be alert for this rare but life-threatening hematological complication following COVID-19 vaccination.

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