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An autopsy case of cerebral arterial thrombosis after vaccination with ChAdOx1 nCOV-19

  • Hyeji Yang (Department of Forensic Medicine, Jeju National University College of Medicine) ;
  • Jaeyoon Ha (Department of Forensic Medicine, Jeju National University College of Medicine) ;
  • Hyun Wook Kang (Department of Forensic Medicine, Jeju National University College of Medicine)
  • 투고 : 2022.06.08
  • 심사 : 2022.08.06
  • 발행 : 2022.08.31

초록

We present a fatal case of cerebral arterial thrombosis after corona virus disease 19 (COVID-19) vaccination with ChAdOx1 nCOV-19. The deceased was a 63-year-old woman with no relevant medical history. She presented symptoms of nausea, fatigue, and headache immediately after vaccination. Ten days after vaccination, she suddenly started vomiting and developed high blood pressure. The patient eventually died 23 days after vaccination. Autopsy findings showed that the cerebral arteries and internal carotid arteries were fully enlarged and were compacted with thrombi. The brain stem showed ischemic necrosis, and extravasation from this necrotic lesion led to focal subarachnoid hemorrhage around the brain stem where large blood clots still remained. No aneurysms or atherosclerotic changes were found in these arteries. We note the following three facts. Firstly, all symptoms occurred immediately after vaccination; secondly, the main cause of death was consistent with known side effects of the vaccine; and lastly, the mechanism of thrombus formation in this case goes beyond the general category of thrombogenesis known so far. While the authors know that this case does not fall into known categories of vaccine side effects, we presenting this case to demonstrate that a comprehensive review of various possibilities related to vaccine side effects is needed to establish a COVID-19 defense system.

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참고문헌

  1. World Health Organization (WHO). WHO coronavirus (COVID-19) Dashboard [Internet]. Geneva: WHO; c2021 [cited 2021 Aug 4]. Available from: https://covid19.who.int/ 
  2. Ritchie H, Ospina EO, Our DB, et al. Coronavirus (COVID-19) vaccinations [Internet]. Jeju: Our World in Data; c2020 [cited 2021 Aug 4]. Available from: https://ourworldindata.org/covid-vaccinations 
  3. European Medicines Agency. Signal assessment report on embolic and thrombotic events (SMQ) with COVID-19 vaccine (ChAdOx1-S [recombinant]) - COVID-19 vaccine AstraZeneca (other viral vaccines) [Internet]. Amsterdam: European Medicines Agency; c2021 [cited 2021 Aug 4]. Available from: https://www.ema.europa.eu/en/documents/prac-recommendation/signal-assessment-report-embolic-thrombotic-events-smq-covid-19-vaccine-chadox1-s-recombinant-covid_en.pdf 
  4. Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: present status and future perspectives. Int J Mol Sci 2020;21:7609. 
  5. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384:2092-101. 
  6. Bussel JB, Connors JM, Cines DB, Dunbar CE, Michaelis LC, Baumann Kreuziger L, et al. Thrombosis with thrombocytopenia syndrome [Internet]. Washington (DC): American Society of Hematology; c2021 [cited 2021 Jul 9]. Available from: https://www.hematology.org/covid-19/vaccine-induced-immune-thrombotic-thrombocytopenia 
  7. Al-Mayhani T, Saber S, Stubbs MJ, Losseff NA, Perry RJ, Simister RJ, et al. Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia. J Neurol Neurosurg Psychiatry 2021;92:1247-8. 
  8. Walter U, Fuchs M, Grossmann A, Walter M, Thiele T, Storch A, et al. Adenovirus-vectored covid-19 vaccine-induced immune thrombosis of carotid artery: a case report. Neurology 2021;97:716-9. 
  9. Zhao B, Ling Y, Li J, Peng Y, Huang J, Wang Y, et al. Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study. Ann Palliat Med 2021;10:1599-609. 
  10. Pearson JD. Endothelial cell function and thrombosis. Baillieres Best Pract Res Clin Haematol 1999;12:329-41. 
  11. Gross PL, Aird WC. The endothelium and thrombosis. Semin Thromb Hemost 2000;26:463-78. 
  12. The Korea Times. Korea reports 1st COVID-19 vaccine-induced blood clotting case [internet]. Seoul: The Korea Times; c2021 [cited 2021 Aug 4]. Available from https://jawww.koreatimes.co.kr/www/nation/2022/06/119_309691.html