Severe headache after adenoviral-vector vaccination against coronavirus disease 2019: a case report

ABSTRACT

Background: Several cases of vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) following exposition to adenoviral- vector vaccines against SARS-CoV-2 were described. The risk of developing intracranial thrombosis is high in subjects with severe headache, thrombocytopenia and d-dimer increase. Clinical Case In July 2021 a 20-year-old woman, without risk factors for thrombosis, presented to the emergency room with headache and hematomas in the lower limbs. Ten days earlier she had received the Ad26.CoV2 vaccine (Johnson & Johnson/Jansenn). The blood tests showed thrombocytopenia, increase in d-dimer value, normal level of hemoglobin. A CT scan with contrast enhancement of the head excluded thrombosis of the intracranial veins or hemorrhage. The patient was hospitalized in the internal medicine ward;on admission she reported severe headache with normal neurological examination. The laboratory studies showed d-dimer 34.430 ng/ml, fibrinogen 64 mg/dl, platelet count 65 x 103/mcl. Upon diagnosis of VIPIT the patient was treated with high dose intravenous immunoglobulins (IVIG), 800 mg/kg for two days. On the second day after IVIG infusion platelet count was 143.000/mmc, d-dimer value 2369 ng/ml and the headache had resolved. Conclusions: The clinical presentation, the laboratory and instrumental findings, the response to the treatment supported a prothrombotic condition, potentially associated with microthrombosis in intracranial smaller veins. Our experience suggests that early use of IVIG can be efficacious in avoiding the evolution into manifest thrombosis.