Endocrine Abstracts

Summary: Vaccine-induced thrombosis and thrombocytopaenia (VITT) is a rare complication associated with the ChAdOx1 (Astra Zeneca, University of Oxford) adenoviral vector vaccine against severe acute respiratory syndrome coronavirus (COVID-19). We herein present the case of a 47-year-old female who developed bilateral adrenal haemorrhage as a sequela to VITT following administration of this vaccine.

Background: A number of cases of unusual thrombosis and thrombocytopenia has been reported in individuals receiving the ChAdOx1 vaccine. This very rare prothrombotic syndrome was termed vaccine-induced thrombosis and thrombocytopaenia (VITT). Here, we present the case of a patient with VIIT complicated by bilateral adrenal haemorrhage.

Case Presentation: A 47-year-old female, presented a few days history of epigastric pain and vomiting. The patient had received her first dose of the AZ vaccine three days prior. During her admission, she developed shortness of breath, fatigue and postural dizziness. Observations were in the normal range. No palmar or buccal pigmentation was noted.

Investigations: Initial blood investigations were normal. Subsequently, the platelet count fell to 10 x 10⁹/l. Blood lactate (6.07 mmol/l) and d-dimer (24,004 μg/l) were elevated. CT abdomen and pelvis with contrast showed bilateral adrenal haemorrhage most likely due to adrenal vein thrombosis. A right pulmonary embolus was also noted. Antiphospholipid syndrome antibodies and antinuclear antibodies (ANA) were negative. Heparin-induced thrombocytopaenia (HIT) screen was positive detecting antibodies against platelet factor 4. Short synacthen test showed suboptimal response.

Treatment: A diagnosis of VITT was made and treatment commenced with intravenous immunoglobulin, the direct thrombin inhibitor argatroban and IV hydrocortisone. Once the platelet count improved, treatment was changed to apixaban, oral fludrocortisone and hydrocortisone.

Discussion: On the backdrop of the vaccination programme against COVID-19, VITT has emerged as a rare but life-threatening complication following AZ vaccine administration. Bilateral adrenal haemorrhage is a potentially devastating complication of VITT.