S3265 A Case of Portal Vein Thrombosis Following COVID Vaccination

Abstract

Introduction: We present a case of portal vein thrombosis in a patient following COVID vaccination. Case Description/Methods: A 44-year-old female with a past medical history of type 2 diabetes mellitus, GERD, tobacco use, asthma, chronic migraines without aura, and COVID infection presents to the emergency department with a one-week history of abdominal pain, back pain, and black stools. She is hemodynamically stable and afebrile. Her labs are significant for elevated AST and ALT at 78 and 200 respectively. CT abdomen/pelvis with IV contrast is obtained and reveals hepatic infarcts with right portal vein thrombosis. She is subsequently started on a heparin drip for treatment. Esophagogastroduodenoscopy reveals gastritis and a 5 mm ulcer in the antrum which is not actively bleeding. Antiphospholipid antibody panel and activated protein C resistance lab results are unremarkable. On further history, the patient reports that she received her first dose of the Moderna COVID vaccine about three weeks prior to presentation. Per gastroenterology, she is able to go home on apixaban 5 mg twice a day for anticoagulation. Follow-up CT abdomen/pelvis three weeks after admission displays significantly improved enhancement pattern throughout the liver with minimal residual heterogeneous enhancement. The patient reports improvement in her abdominal pain during follow-up appointments, and her liver enzymes are trending back to normal levels. She follows up outpatient with hematology/oncology, however her hypercoagulable lab work-up continues to be unremarkable. Discussion: This case demonstrates that portal vein thrombosis may occur following COVID vaccination. The timeline of her developing portal vein thrombosis soon after receiving the COVID vaccination may be suggestive of the vaccine precipitating her condition. This patient did have an additional risk factor of tobacco use. This can be a challenging situation for many clinicians to navigate, as COVID remains a significant threat to patients’ health. Patients with hypercoagulable risk factors may benefit from close monitoring for abdominal pain or other symptoms surrounding COVID vaccination.