TY - JOUR
T1 - Fatal thrombotic microangiopathy with rhabdomyolysis as an initial symptom after the first dose of mRNA–1273 vaccine
T2 - A case report
AU - Kamura, Yuya
AU - Terao, Toshiki
AU - Akao, Satoshi
AU - Kono, Yumi
AU - Honma, Koichi
AU - Matsue, Kosei
N1 - Funding Information:
We would like to thank the staff of hematology/oncology, rheumatology, and intensive care medicine of Kameda Medical Center for their dedicated efforts to care for this patient. We are grateful to Dr. Toshiyuki Karumai (Intensive Care Medicine, Kameda Medical Center, Chiba, Japan) for critical review of the manuscript. We would also like to thank Dr. Atsushi Yasumoto (Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Japan) and Dr. Eriko Morishita (Department of Hematology, Kanazawa University Hospital, Japan) for the measurement of anti-PF4 antibody by enzyme-linked immunosorbent assay. The measurement of anti-PF4 antibody (ELISA) was supported by Agency for Medical Research and Development (AMED) under Grant Numbers JP20ek0210154. We also thank Editage ( https://www.editage.jp/ ) for English language editing.
Funding Information:
We would like to thank the staff of hematology/oncology, rheumatology, and intensive care medicine of Kameda Medical Center for their dedicated efforts to care for this patient. We are grateful to Dr. Toshiyuki Karumai (Intensive Care Medicine, Kameda Medical Center, Chiba, Japan) for critical review of the manuscript. We would also like to thank Dr. Atsushi Yasumoto (Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Japan) and Dr. Eriko Morishita (Department of Hematology, Kanazawa University Hospital, Japan) for the measurement of anti-PF4 antibody by enzyme-linked immunosorbent assay. The measurement of anti-PF4 antibody (ELISA) was supported by Agency for Medical Research and Development (AMED) under Grant Numbers JP20ek0210154. We also thank Editage ( https://www.editage.jp/) for English language editing. The authors declare no conflicts of interest associated with this manuscript. Y.Kamura. T.T. and K.M. wrote and edited the manuscript and performed patient care and literature review. S.A. and Y.Kouno. provided patient care. K.H. performed the pathological review. K.M. also supervised the study. All authors read and approved the final manuscript. The patient's family provided consent for the publication of this case with the removal of all identifying information to remain anonymous and retain his privacy.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/4
Y1 - 2022/4
N2 - We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs. Antiplatelet factor 4 antibody test was negative. Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination.
AB - We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs. Antiplatelet factor 4 antibody test was negative. Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination.
KW - complemental activation
KW - COVID-19
KW - mRNA-1273
KW - rhabdomyolysis
KW - SARS-CoV-2
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85125531586&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85125531586&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2022.02.031
DO - 10.1016/j.ijid.2022.02.031
M3 - Article
C2 - 35189339
AN - SCOPUS:85125531586
SN - 1201-9712
VL - 117
SP - 322
EP - 325
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -
