A rare case of COVID-19 vaccine-induced thrombotic thrombocytopaenia (VITT) involving the veno-splanchnic and pulmonary arterial circulation, from a UK district general hospital

BMJ Case Rep. 2021 Sep 17;14(9):e244223. doi: 10.1136/bcr-2021-244223.


A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins. In a time where there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalisation, this particular clinical scenario emphasises the need of all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.

Keywords: COVID-19; immunological products and vaccines; portal vein; pulmonary embolism; vaccination/immunisation.

Publication types

  • Case Reports

MeSH terms

  • COVID-19 Vaccines
  • COVID-19*
  • Female
  • Hospitals, General
  • Humans
  • Hypertension, Pulmonary*
  • Middle Aged
  • Pulmonary Artery
  • SARS-CoV-2
  • Thrombocytopenia*
  • Thrombosis*
  • United Kingdom
  • Vaccines*


  • COVID-19 Vaccines
  • Vaccines