Case Discussion
A 25-year-old woman with an unremarkable medical history presented to the emergency department with severe abdominal pain; There were no clinical signs of COVID-19; 10 days before the presentation, she received the first dose of the Cov-19 vaccination (AstraZeneca). She had no history of any thromboembolic or connective tissue disorders. She was not on oral contraceptive pills or herbal remedies. Ultrasound was done suspecting pancreatitis. However, serum amylase was normal.
2 days later, an abdomen CT was obtained, which revealed massive thrombosis of the entire portal venous system with no residual enhancement in the portal vein, splenic vein, and superior mesenteric vein; mild intraabdominal free fluid was noted in the Pelvis and peripancreatic area.
Laboratory workup revealed thrombocytopenia (Platelet 112*109/L) and elevated d-dimer (33.5 mg/L) but was otherwise normal, showed a normal white blood cell count at 9.2×10"9/L, normal haemoglobin at 12.7 g/dL. Her coagulation profile showed slightly prolonged PT (13 s), normal PTT (32s), and INR (1.2).
We assumed the diagnosis was a vaccine-induced immune thrombotic thrombocytopenia and anticoagulant therapy started; the patient’s condition rapidly improved; her pain subsided, and her platelet count reached 230 × 109 per L 72 h starting treatment also D-dimer concentrations dropped.
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