Relapse of immune thrombotic thrombocytopenic purpura (iTTP) possibly triggered by COVID-19 vaccination and/or concurrent COVID-19 infection

BMJ Case Rep. 2022 Jul 28;15(7):e247524. doi: 10.1136/bcr-2021-247524.

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease that may be triggered by inflammation, including infection or vaccination. Since the start of the COVID-19 pandemic, several case reports were published on de novo or relapsed immune TTP (iTTP) in COVID-19-infected patients. Case reports of iTTP episodes following vaccination against COVID-19 are also emerging. We report a case of relapsed iTTP in a patient who received Moderna mRNA-1273 SARS-CoV-2 vaccine and developed concurrent severe COVID-19 infection. The patient's iTTP was successfully managed with caplacizumab, therapeutic plasma exchange and high-dose steroids. We summarise published cases of iTTP associated with COVID-19 infection or vaccination.

Keywords: COVID-19; Thrombotic Thrombocytopenic purpura; Vaccination/immunisation.

Publication types

  • Case Reports

MeSH terms

  • 2019-nCoV Vaccine mRNA-1273
  • COVID-19 Vaccines* / adverse effects
  • COVID-19* / pathology
  • COVID-19* / prevention & control
  • Humans
  • Pandemics
  • Plasma Exchange
  • Purpura, Thrombocytopenic, Idiopathic* / chemically induced
  • Purpura, Thrombocytopenic, Idiopathic* / therapy
  • Purpura, Thrombotic Thrombocytopenic* / chemically induced
  • Purpura, Thrombotic Thrombocytopenic* / therapy
  • Recurrence
  • SARS-CoV-2
  • Vaccination / adverse effects

Substances

  • COVID-19 Vaccines
  • 2019-nCoV Vaccine mRNA-1273