First report of a de novo iTTP episode associated with an mRNA-based anti-COVID-19 vaccination

J Thromb Haemost. 2021 Aug;19(8):2014-2018. doi: 10.1111/jth.15418. Epub 2021 Jul 5.


Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially life-threatening thrombotic microangiopathy, characterized by disseminated thrombus formation in the microvasculature, causing severe organ failure. Immune-mediated TTP (iTTP) is occasionally described after vaccination, especially against viral agents. We report a case of a 38-year-old woman with a de novo iTTP after exposure to the mRNA-based anti-coronavirus disease 2019 (COVID-19) vaccine produced by Pfizer-BioNTech. She presented with increased bruising and petechiae starting 2 weeks after receiving the first dose of the anti-COVID-19 vaccine. Laboratory data revealed a severe ADAMTS13-deficiency in combination with a very high autoantibody titer against ADAMTS13. She was successfully treated with plasma exchange, corticosteroids, rituximab, and caplacizumab. To our knowledge, this is the first case report of iTTP after mRNA-based COVID-19 vaccination in a previously TTP-naïve patient.

Keywords: COVID-19; corticosteroids; plasmapheresis; purpura; thrombotic thrombocytopenic; vaccination.

Publication types

  • Case Reports

MeSH terms

  • ADAMTS13 Protein
  • Adult
  • COVID-19 Vaccines
  • COVID-19*
  • Humans
  • Purpura, Thrombotic Thrombocytopenic*
  • RNA, Messenger / genetics
  • SARS-CoV-2
  • Vaccination


  • COVID-19 Vaccines
  • RNA, Messenger
  • ADAMTS13 Protein