Background: It is widely known that viruses can cause autoimmune disorders. Since 2019 medical community has been convinced, that SARS COV2 can also initiate such autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, etc. In our hospital we faced a clinical case of thrombotic thrombocytopenic purpura (TTP) after vaccination and SARS COV2 – infection
Aims: to clarify more possible autoimmune disorders induced by COVID 19 and complications after vaccination against SARS COV2
Methods: A 72-year-old man was admitted to hematological department in August 2021 because of rapidly worsening general condition, hemolytic anemia (hemoglobin 6.82 mmol/l, hematocrit 1,28), and thrombocytopenia (28 Gpt/l) for unknown reasons. Additionally, he was found to have an elevated lactate dehydrogenase (63.42 μmol/l/s) and bilirubin (86 μkmol/l/s). Direct and indirect Coombs test were negative. He was also presented with cognitive defects and neurologic disorders. It is known from the case history, that he had been vaccinated against SARS COV2 with one of the Russian vaccines one months before admitting to our clinic. After that he was admitted to the hospital with SARS COV2 –associated pneumoniae. He underwent a course of therapy, including anticoagulants and IL-6 inhibitors. When pneumonia regressed, he was discharged. But one week later he started to feel worse. We suggested autoimmune hemolytic anemia and gave him steroid pulse therapy according to vital indications, with no improvement. The differential diagnostic was continued among hemolytic-uremic syndrome, TTP, cancer, autoimmune disorder and viral infections. We detected extremely low level of protease ADAMTS13 (5%) and diagnosed TTP. We started daily plasma exchange #15, which ended with complete remission of the disease – total regress of cognitive defects and neurologic disorders, rapid raise of thrombocyte level and hemoglobin.
Results: Our patient was completely cured. We have 6 months of observation data on him. There were no relapses of TTP during this time. The cause of manifestation of the TPP in 72 year- old patient remained unclear. To date, there are more and more cases of autoimmune diseases after vaccination and COVID 19. In particular, one similar case of TTP after Pfizer vaccine injection was already described.
Summary/Conclusion: Thus, previous vaccination and coronavirus infection, could be the possible causes of TTP in this case. However, another equally important question still remains open – what exactly contributed to autoimmunization - vaccination or COVID 19. Further research is required. That is why more careful selection of patients for vaccination is required.