Abstract
SARS-CoV-2 infection is associated with an increased rate of thromboembolic events and mortality. Different vaccines are globally used to limit the pandemic. In this report, we present the case of two young female patients with newly diagnosed cerebral sinus vein thrombosis occurring after injection of the vector-based ChAdOx1 vaccine. Both patients presented with unusual headache only. The two of them used an estrogen-containing contraception, had had a history of deep venous thrombosis, and both had MTHFR mutations. Both patients developed SARS-CoV-2 specific humoral and cellular immunity including both CD4 and CD8 T cells. This rare, but serious complication needs to be considered after vaccination of young females, even if there is no evidence of heparin-induced thrombocytopenia.
Highlights
Case descriptionIn the fight against Coronavirus Disease (COVID) 19 pandemic, vaccines such as AstraZeneca adenovirus vectorbased vaccine ChAdOx1 play a major role
There is a growing body of evidence that in a small number of patients, ChAdOx1 is associated with a higher risk for developing cerebral sinus vein thrombosis (CSVT), a relatively uncommon coagulation disorder with an incidence of about 3–4 cases per 1 million population [1]
Infection with SARS-CoV-2 can lead to venous thromboembolism, ischemic stroke, and, more rarely, CSVT [3]
Summary
In the fight against Coronavirus Disease (COVID) 19 pandemic, vaccines such as AstraZeneca adenovirus vectorbased vaccine ChAdOx1 play a major role. There were no signs of infection, and no neurological deficits or increased intracranial pressure-related symptoms existed Flow cytometric analysis showing (Fig. 1f, g) activated CD4 and CD8 T cells producing IFN-g after stimulation with overlapping peptides derived from the spike protein. 21 days after vaccination, SARS-CoV-2 IgG blood titer was 650 AU/ml in patient A and > 16,500 AU/ml in patient B Both patients had developed vaccine-specific cellular immunity, as shown by flow-cytometric analysis of the specific T-cell reactivity after whole blood stimulation with overlapping peptides from the SARS-CoV-2 spike protein [2], (Fig. 1f, g). Anticoagulation with low-molecular-weight heparin was started and later replaced by phenprocoumon Both patients were discharged after 1 week without any neurological symptoms
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