AZD-1222

Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

In case series, a 46-year-old man and a 38-year-old woman were described, who developed vaccine-induced immune thrombocytopenia and thrombosis (VITT) after immunization with AZD-1222 [routes, dosages and outcomes not stated].

Case 1: The 46-year-old man presented for abdominal pain and back pain. He was a smoker and alcohol user. He had received the first dose of SARS-CoV-2 vaccine AZD-1222 (Oxford–AstraZeneca) around eight days prior to the presentation. His pain was dull and aching in nature and mainly in the epigastric and umbilical regions of the abdomen and also bilaterally in the lower back. CT abdomen and pelvis exhibited an enlarged, hyperdense right adrenal gland with surrounding fat stranding, consistent with acute haemorrhage. Regarding clinical evidence of adrenal insufficiency, no haemodynamic compromise was found, and biochemistry showed normal levels of sodium, glucose, potassium and acid-base status. A baseline random cortisol level was found to be 87 nmol/L, which confirmed adrenal insufficiency. Therefore, a diagnosis of VITT was made. CT pulmonary angiogram showed a new left-sided adrenal haemorrhage. He received treatment with methylprednisolone. He was administered hydrocortisone empirically when adrenal involvement was first identified. He was discharged with steroid tapered and fludrocortisone was started.

Case 2: The 38-year-old woman presented for abdominal pain and back pain. She had a history of gastro-oesophageal reflux disease, obesity, osteoarthritis and spondyloepiphyseal dysplasia with previous joint replacements and spinal surgeries. She had received her first dose of SARS-CoV-2 vaccine AZD-1222 (Oxford–AstraZeneca) around 11 days prior to the presentation. The abdominal pain was initially generalised but then localised to the upper abdomen and radiated to the back. She also developed headache and vomiting. CT abdomen and pelvis exhibited a filling defect in the distal portion of the left renal vein, which was consistent with thrombosis and an enlarged left adrenal gland, with loss of shape and decreased attenuation, in keeping with evolving infarction and post-infarction necrosis. Therefore, a diagnosis of VITT was made in the setting of the radiologically evident thrombosis in the left renal vein and a number of haematological findings. A repeat CT scan showed left adrenal infarction without evidence of haemorrhagic transformation. She received treatment with methylprednisolone. Later, she was discharged with oral hydrocortisone.