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Idiopathic Thrombotic Microangiopathy with ChAdOx1 nCov-19 Vaccination in a Middle Aged Male: A Clinical Challenge in the Covid Era

Mobin Paul, Latha Abraham, Sophy, Dasary Varghese, Jose Thomas, Jaicob Varghese, Sunesh Edakkattil Radhakrishnan

Thrombotic thrombocytopenic purpura (TTP) is defined as thrombotic microangiopathy occurring in the context of severe ADAMTS13 deficiency (<10%) which is a normal enzyme in plasma that cleaves large forms of von Willebrand factor into smaller functional subunits. We report a case of a middle aged male with de novo iTTP ( idiopathic thrombotic thrombocytopenic purpura) after vaccination with ChAdOx1 nCov-19. He presented with severe abdominal pain, increased bruising, hematuria along with episodes of transient ischemic attacks, 5 days from the first dose of the antiCOVID-19 vaccine. Laboratory data revealed a very severe ADAMTS13 deficiency, however, autoantibody titer could not be measured due to the failure of refrigerating facility in our reference laboratory. Patient was successfully treated with serial plasma exchange and immunosuppression with steroids and rituximab.