ABSTRACT
Background: Rare cases of acquired thrombotic thrombocytopenic purpura (aTTP) have been reported since the administration of the COVID-19 vaccination. Based on our information, the present study provides the first case report of aTTP developed after the COVID-19 vaccination in Iran. Case presentation: A 22-year-old Iranian woman presented with symptoms of ataxia, dysphasia, paresthesia, and acute numbness of her left upper limb four weeks after the AstraZeneca COVID-19 vaccination. Laboratory data suggested hemolytic anemia and thrombocytopenia. Also, schistocytes were noted on her peripheral blood smear. Acquired thrombotic thrombocytopenic purpura (aTTP) was diagnosed in accordance with clinical manifestations along with initial blood test results and was confirmed later through findings of ADAMTS-13 low level activity and the ADAMTS-13 positive inhibitor. She underwent 22 sessions of plasma exchange, receiving corticosteroid and rituximab. Finally, the treatment was successful. Conclusion: Despite the presence of rare complications such as aTTP, vaccination is one of the best ways to prevent COVID-19 disease. The present case report describes the potential, but unproven, role of the AstraZeneca COVID-19 vaccine in aTTP pathogenesis. Vaccine-associated aTTP can be successfully treated with plasma exchange, corticosteroids, and rituximab.