Table 1.
Patients from respective case reports included in the analysis.
| Author, year | Age | Gender | Past medical history | Vaccine type | Clinical presentation | Onset of symptoms after vaccination | ADAMTS13 activity; autoantibody titers if reported; any other labs | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Yocum et al., 2021 [11] | 62 | F | HTN, HLD, hypothyroidism, GERD | Ad26.COV2-S | Acute onset of altered mental status | 37 days | <12%; no antibody documentation, however PF4 negative | PLEX and steroids | Unknown |
| Waqar et al., 2021 [6] | 69 | M | HTN, CKD, HIV (on HAART, with CD4 count 354), Hepatitis B, DVTs (on warfarin) | BNT162b2 (second dose) | Fatigue and dyspnea | 7 days | <2%; >90 IU/mL | PLEX, steroids, and rituximab | Discharged on outpatient rituximab |
| Sissa et al., 2021 [12] | 48 | F | Relapsing TTP | BNT162b2 (Second dose) | Ecchymoses | 6 days | <3%; 88 U/mL | PLEX and steroids | Discharged |
| Maayan et al., 2021 [13] | 40 | F | None | BNT162b2 (Second dose) | Somnolence, fever, hematuria, petechiae and ecchymoses | 8 days | 0%; 51 U/mL | PLEX, steroids and caplacizumab | Discharged with monitoring |
| Maayan et al., 2021 [13] | 28 | M | Morbid obesity | BNT162b2 (Second dose) | Dysarthria | 28 days | 0%; 113 U/mL | PLEX, steroids, caplacizumab and rituximab | Discharged with monitoring |
| Maayan et al., 2021 [13] | 31 | F | Recurrent TTP | BNT162b2 (First dose) | Vaginal bleeding and purpura | 13 days | 0%; 64 U/mL | PLEX, steroids, caplacizumab and rituximab | Discharged On caplacizumab |
| Maayan et al., 2021 [13] | 30 | M | Single episode of TTP 7 years prior | BNT162b2 (Second dose) | Purpura | 8 days | 0%; 21 U/mL | PLEX, steroids, caplacizumab and rituximab | Discharged with monitoring |
| Bruijn et al., 2021 [14] | 38 | F | None | BNT162b2 (first dose) | Petechiae, blurred vision due to central serous chorioretinopathy | 14 days | 0%; >1000 AU/mL; PF4 negative, high IgG antibodies against S1 receptor binding domain of SARS-CoV-2 (93.8 U/mL) | PLEX, steroids, low dose acetylsalicylic acid, caplacizumab and rituximab | Discharged with monitoring |
| Lee et al., 2021 [15] | 50 | F | HTN | ChAdOx1 nCoV-19 (first dose) | dysphasia, left upper extremity numbness and petechiae | 12 days | 0%; >94.93 U/mL, PF4 negative | PLEX, steroids, and rituximab | Discharged on tapering steroids |
| Guney et al., 2022 [16] | 48 | F | None | BNT162b2 (first dose) | Weakness, nausea, dizziness, and bruising | 3 days | <0.2%; >90 IU/mL | PLEX, steroids and rituximab | Unknown |
| Osmanodja et al., 2021 [17] | 25 | M | None | mRNA-1273 (first dose) | Malaise, fever, aphasia, vomiting, headache, petechiae and hematuria | 4 days | <1%; 72.2 IU/mL; PF-4 and enhanced platelet activation test negative | PLEX, steroids, caplacizumab and rituximab | Discharged on daily caplacizumab |
| Al-Ahmad et al., 2021 [18] | 37 | M | Heavy smoker complicated by secondary polycythemia and recent venesection (1 week) | ChAdOx1 nCoV-19 (first dose) | Dizziness, fatigue, headache, dyspnea hematuria, ecchymoses, and palpitations | 10–15 days | 2.6%; unknown titers but present | PLEX, steroids and rituximab | Discharged on rituximab and steroid taper |
| Yoshida et al., 2022 [19] | 57 | M | None | BNT162b2 (first dose) | Fatigue, jaundice, and appetite loss | 7 days | <0.5%, 1.9 BU/mL; PF-4 negative; high IgG antibodies (two types) against receptor binding domain of SARS-CoV-2 spike protein (23.5 AU/mL and 153 U/mL) | PLEX, steroids and rituximab | Discharged |
| Ruhe et al., 2022 [20] | 84 | F | None | BNT162b2 (first dose) | Petechiae, hypertension, and Partial hemiplegia due to subacute emboli | 16 days | 1.6%, 82.2 U/mL; PF-4 negative; HIPA and PIPA negative; high IgG antibodies against SARS-CoV-2 spike protein (28.6 AU/mL) | PLEX, steroids and rituximab | Improved |
| Giuffrida et al., 2021 [21] | 83 | F | Undifferentiated connective tissue disease (on low-dose steroids) and steroid induced DM | BNT162b2 (first dose) | Hematuria and petechiae | 14 days | <10%; 40 U/mL | PLEX, steroids and caplacizumab | Death after 2 days of treatment |
| Giuffrida et al., 2021 [21] | 30 | F | Beta-thalassemia carrier | BNT162b2 (first dose) | Headache, fatigue, and petechiae | 18 days | <10%; 77.6 U/mL | PLEX, steroids and caplacizumab | Discharged on caplacizumab |
| Kirpalani et al., 2022 [22] | 14 | F | Anxiety, iron deficiency, and postprandial abdominal pain with family history of maternal ITP | BNT162b2 (first dose) | Fatigue, headache, confusion, and petechiae | 14 days | < 1%; 72 μ/mL; boderline IgA and IgG antibodies against SARS-CoV-2 spike protein (checked after initiation of PLEX – unknow titers) | PLEX, steroids, caplacizumab and rituximab | Improved |
| Chamarti et al., 2021 [23] | 80 | M | HTN, DM (type II), HLD, Gout, iron deficiency anemia | BNT162b2 (second dose) | Malaise, weakness and petechiae | 12 days | <2%; 182% | PLEX, steroids, and rituximab | Discharged on rituximab |
| Innao et al., 2022 [24] | 33 | F | Lymphoma status post chemotherapy and allogenic HSCT (in remission for last 11 years), was on hormone therapy for unknown reasons | BNT162b2 (first dose) | Asthenia, headache, purpura, drowsiness, and nausea with abdominal pain | 9 days | 8%; defective sample – no comment on titers | PLEX, steroids and caplacizumab | Discharged on steroid taper and caplacizumab |
| Agbariah et al., 2021 [25] | 60 | M | Ischemic stroke one week after first dose of BNT162b2 | BNT162b2 (second dose) | Retrosternal pain and confusion | 10 days | <5%; negative; non-inhibitory ADAMTS13 IgG autoantibodies were weakly positive; PF-4 negative | PLEX and steroids | Improved |
| Pavenski et al., 2021 [26] | 84 | M | Immune TTP (diagnosed 14 months ago), Remote treated prostate cancer, gout, HLD, HTN, DM (Type II) | BNT162b2 (first dose) | Lethargy, myalgias and anorexia | 7 days | <1%; >15 IU/mL | PLEX, steroids, caplacizumab and rituximab | Discharged |
| Duecher et al., 2022 [27] | 28 | F | Immune TTP (diagnosed 30 months ago) | BNT162b2 (first dose) | Bruising and ataxia | 6 days | Undetectable; unknown | Prednisone, rituximab and caplacizumab (experience with use of Caplacizumab without PLEX) | Discharged on weekly rituximab |
| Wang et al., 2021 [29] | 75 | M | None | ChAdOx1 nCov-19 | Bleeding from tongue | 30 days | 0.8%; unknown; PF-4 complex antibodies negative | PLEX | Unknown |
| Karabulut et al., 2021 [30] | 48 | M | DM (Type II on insulin), TTP (8 years ago), ITP (5 years ago), COVID-19 pneumonia (2 months prior to presentation) | mRNA-1273 (First dose) | Paresthesia, Transient weakness, and dysarthria | 5 days | <3%; 6.6 BEU | PLEX, steroids and rituximab | Discharged on rituximab and steroid taper |
| Francisco et al., 2021 [31] | 57 | M | Immune TTP (5 years) | mRNA-1273 (second dose) | Petechiae | 49 days | <5%; titer 1.5 (normal <0.4) | PLEX, steroids, caplacizumab and rituximab | Discharged on rituximab and caplacizumab, however 3 weeks after completion of caplacizbumab (30 days duration), he had a relapse |
| Alislambouli et al., 2021 [32] | 61 | M | None | Pfizer (first dose) | Confusion, fever, headache, dark urine, and ecchymosis, with seizures on arrival (only patient with classic pentad) | 5 days | <3%; unknown | PLEX, steroids and rituximab | Discharged on rituximab and steroid taper |
| Dykes et al., 2022 [33] | 50 | F | Congenital TTP (maintained on plasma infusion every 4–6 weeks since 2016 - infusion got delayed by 2 weeks) | mRNA-1273 (second dose) | Malaise, neurologic deficits with seizures in ER | 7 days | <5%; no inhibitors as congenital, PF4 and SRA negative | Plasma infusions | Improved |
HTN: hypertension; HLD: hyperlipidemia; GERD: gastro-esophageal reflux disease; CKD: chronic kidney disease; HIV: human immunodeficiency virus; HAART: highly active anti-retroviral therapy; DVT: deep venous thrombosis; HIPA: heparin-induced platelet antibody; PIPA: platelet- iodinated protein A; PF4: platelet factor 4 heparin complex antibody; HSCT: hematopoietic stem cell transplant; PLEX: plasmapheresis; PF4: platelet factor 4.