Table 1. Clinical, instrumental, and hematological parameters of the patient before and after TPE interventions.
TPE: therapeutic plasma exchange; ETAR: endothelin A receptor; ADRA1A: alpha-1A adrenergic receptor; ADRB1: beta-1 adrenergic receptor; ADRB2: beta-2 adrenergic receptor; CHRM1,2,3,4,5: muscarinic acetylcholine receptor 1,2,3,4,5; ACE2: angiotensin converting enzyme 2, coronavirus spike receptor; MAS1: MAS1 receptor, activated by binding angiotensin-(1-7); CXCR3: chemokine receptor CXCR3
| Clinical parameters | Therapeutic plasma exchange | ||||
| Before | After | Notes | |||
| Date | Values/findings | Date | Values/findings | ||
| Angio-CT and MRI of the brain | 20 Mar 2021 | Cerebral venous sinus thrombosis | |||
| Abdominal CT scan | 21 Mar ‘21 | Intrahepatic portal vein thrombosis | |||
| Platelets/µl | 22 Mar ‘21 | 18,000/μL | 24 Mar ‘21 | 23,000/μL | 67,000/ml after platelet transfusion |
| 29 Mar ’21 | 118,000/μL | ||||
| Fibrinogen | 22 Mar ‘21 | 72 mg/dl | 24 Mar ‘21 | 143 mg/dl | |
| Antithrombin III | 22 Mar ‘21 | 60.9% | 24 Mar ‘21 | 85.9% | |
| D-dimer | 22 Mar ‘21 | 26.93 mg/l | 24 Mar ‘21 | 17.02 mg/l | |
| Anticoagulation therapy | 22 Mar ‘21 | Too risky | 29 Mar ’21 | Resumed fondaparinux | Anticoagulation therapy well-tolerated |
| Brain conditions | 20 Mar ‘21 | Severe headache, subtle left emi syndrome with defective grip, difficulty in carrying out even simple calculations | 7 Apr ‘21 | Superior sagittal sinus recanalization | |
| Abdominal conditions | 21 Mar ‘21 | Severe endo-abdominal hemorrhage and hemorrhagic shock | 7 Apr ‘21 | Improved abdominal condition, removal of the abdominal drain | |
| Discharge from hospital | 2 May ‘21 | Clinical improvement, normal coagulation parameters | A feeling of temporary discomfort, asthenia, and difficulty concentrating, which persisted in 2021 and 2022 | ||
| Epileptic crisis | 3 Jan 2023 | Generalized and focal seizures of tonic-clonic type | 25 oct ‘23 and 28 Nov ‘23 | No more neurological symptoms | |
| Long post-COVID-vaccination syndrome | Jan-Oct ‘23 | Asthenia, trembling of right arm, fatigue, loss of stability, extreme difficulty concentrating, postural orthostatic tachycardia | 25 oct ‘23 and 28 Nov ‘23 | Marked clinical improvement | As of April 2024, the patient leads a normal life and does not take medications |
| Autoantibodies panel | 3 Aug ‘23 | Elevated levels of ETAR, ADRA1A, ADRB1, ADRB2, CHRM3, CHRM4, ACE2, MAS1, CXCR3 | 28 Nov ‘23 | Normalization of ETAR, ADRA1A, ADRB1, ADRB2, CHRM3, CXCR3, increase of ACE2, MAS1 | |