| Patient 1 | Patient 2 |
---|---|---|
Age and sex | 55-years-old woman | 45-year-old man |
Preexisting conditions and screening for thrombophilia | No preexisting conditions. MTHFR A1298C homozygous mutation | Body mass index of 30 Screening negative |
Symptoms and timing since vaccine administration | Low-grade fever and headache developed one week after vaccination | History of headaches 23 days after vaccination |
Admission clinical picture, platelet count, and D-dimer (reference value 0–0.5ug/ml) | Alert and cooperative, headache Platelet count: 31,000 per cubic millimeter D-dimer > 4ug/ml | Acute focal neurologic motor deficit and altered level of consciousness Platelet count: 125,000 per cubic millimeter D-dimer > 4ug/ml |
Sites of thrombosis during clinical course | Pulmonary subsegmental arteries thrombosis Thrombosis of the right internal jugular vein, absent signal void at straight sinus and at right transverse sinus (Fig. 1A–D) Portal vein branch thrombosis and partial thrombosis of inferior cava vein. Extension of thrombosis at mesenteric superior vein, main branches of portal vein, and sovraepatic branches | Massive thrombosis of the right transverse-sigmoid and of superior sagittal sinuses associated with a right intracerebral hemorrhagic infarction and midline shift (Fig. 1E–H) No signs of thrombosis were found in any other distric. |
Therapy and interventions | Methylprednisolone, fondaparinux, intravenous immunoglobulins | Dexamethasone, fondaparinux, intravenous immunoglobulins |
Antibodies to platelet factor 4, reference value < 0.400 OD | 1.126 OD | 2.37 OD |
Evolution | Neurological deteriorations on day 2, pupils became anisocoric, Glasgow Coma Scale was 3 Cerebellar hemorrhage and diffuse cerebral edema with transtentorial herniation Emergency posterior decompressive craniectomy, intracranial pressure monitoring, external ventricular drainage. Refractory intracranial hypertension Death by neurologic criteria was declared on day 8 | Pupils were dilated and fixed and Glasgow Coma Scale was 3. Neurosurgical consult excluded further intervention for futility due to poor grade prognosis Central venous oxygen saturation was 92%, without clinical signs of sepsis Death by neurologic criteria was declared on day 3 |
Organ donation and transplanted organs | Organ donation per previously expressed wish to donate Kidneys and corneas transplanted | Organ donation per previously expressed wish to donate Lungs, liver, kidneys. and corneas transplanted |
Outcome in organ recipients | Good at 6 months | Good at 6 months |