A newly diagnosed Budd-Chiari Syndrome with thrombotic thrombocytopenia after BTN162b2 vaccination

ABSTRACT

Objectives: Worldwide, Pfizer/BioNTech (BTN162b2) mRNA vaccine is now under massive use to be protected from COVID-19, although it may cause thrombotic thrombocytopenia in rare cases. Budd-Chiari syndrome (BCS) is a rare condition and is defined as the obstruction of hepatic venous outflow. Materials and Methods: A 34-year-old woman who was vaccinated with first dose of BTN162b2 6 weeks ago newly developed ascites, liver dysfunction, and thrombocytopenia. Results: Contrast-enhanced CT scan, doppler ultrasound, and hepatic venography showed complete obstruction of three major hepatic veins without membranous structure and without any collaterals, causing portal hypertension and liver dysfunction. Percutaneous liver biopsy showed diffusion dilation of sinusoids with extensive hepatocyte dropout, although there was no portal inflammation or fibrosis. The patient was treated with anticoagulants and intravenous immunoglobulin. After 6 weeks of anticoagulation, hepatic venous outflow became well detectable by doppler ultrasonography and ascites disappeared. Conclusion: This is a rare case of acute BCS with thrombotic thrombocytopenia after BNT162b2 mRNA vaccination.