Imaging findings in a patient with suspected vaccine induced immune thrombotic thrombocytopenia

Covid-19 vaccine was developed in response to the SARS Cov2 pandemic. Despite the effectiveness of the vaccine, various complications have been reported after vaccination. We present the case of a 55-year-old patient with post-vaccination complication. The patient was vaccinated with ChAdOx1 nCov-19 Vaccine and 2 weeks later presented with headache, confusion and abdominal pain for 1 week duration. Clinical examination demonstrated reduced Glasgow Coma Scale (GCS), reduced muscle power bilaterally and dysphasia. Blood test showed thrombocytopenia, high titres of D-Dimer and mildly raised INR. The CT scan of the head showed a fairly large left temporoparietal intracranial hemorrhage with midline shift and subsequent CT venogram demonstratedthrombosis of the left transverse and sigmoid dural venous sinuses. CT scan of the abdomen and pelvis showed thrombosis of the portal and hepatic veins and multiple infarcts of the liver, left kidney and lingular segment of the partially imaged lungs (Figure 2). Patient tested positive for antibodies directed against platelet factor-4 and was treated for vaccine induced thrombotic thrombocytopenia. Treatment included Intravenous immunoglobulin, Fresh Frozen Plasma, non-heparin based anticoagulant and required care in tertiary center. Incidence of vaccine-induced immune thrombotic thrombocytopenia is unknown and strongly mimics autoimmune heparin-induced thrombocytopenia with typical clinical features of thrombocytopenia and thrombosis. Of the reported cases, the common imaging finding is thrombosis in various sites such as cerebral venous thrombosis, portal vein thrombosis, pulmonary embolism and ischemic stroke.