SHM Converge Scientific Abstract ePoster Gallery-Central Venous Sinous Thrombosis in a Male After Ad26.cov2.s Vaccination

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This case report describes thrombosis with thrombocytopenia syndrome (TTS) after Johnson & Johnson/Janssen Ad26.COV2.S COVID-19 vaccination in a previously healthy 57-year-old man, highlighting an uncommon but serious vaccine-associated complication.<br /><br />The patient received the vaccine 13 days before presentation and had endoscopic sinus surgery 5 days later. He then developed 4 days of severe headache with transient blurry vision, left leg swelling and pain, thigh bruising, episodic right-hand numbness/weakness, and worsening shortness of breath. Initial labs showed profound thrombocytopenia (platelets 6,000/μL), very high D-dimer, and low fibrinogen, raising concern for immune thrombocytopenia versus TTS.<br /><br />Imaging and workup revealed extensive thrombotic disease, including left lower-extremity deep venous thrombosis, bilateral pulmonary emboli, subarachnoid hemorrhage, bilateral cerebellar infarcts, and occlusive thrombus in the superior sagittal sinus consistent with cerebral venous sinus thrombosis (CVST). A positive PF4 ELISA supported the diagnosis of TTS.<br /><br />Treatment included dexamethasone, platelet transfusions, plasma exchange, IVIG, and later therapeutic rivaroxaban. By day 8, platelet counts recovered to 278,000/μL, symptoms improved, and the patient was discharged on a short prednisone taper. At 3- and 9-month follow-up, he remained symptom free with stable platelets and negative anti-PF4 testing; anticoagulation was eventually stopped.<br /><br />The presentation emphasizes that TTS can occur after Ad26.COV2.S vaccination, including in males and in the setting of recent surgery. Key messages include early recognition, prompt treatment with IVIG and non-heparin anticoagulation, and current CDC/ACIP preference for mRNA vaccines over Ad26.COV2.S, while noting that vaccination remains preferable to being unvaccinated.

Asset Subtitle

James F. Wu

Meta Tag

Author List Hammad Muhammad, James F. Wu, Umair Bajwa

Category Clinical Vignettes

Concept Thrombosis with Thrombocytopenia Syndrome

Concept Thrombocytopenia

Concept Ad26COV2S Vaccine

Concept Transverse Sinus Thrombosis

Concept D-dimer

Distinguished Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author James F. Wu

Track Adult

Keywords

thrombosis with thrombocytopenia syndrome

Johnson & Johnson vaccine

Ad26.COV2.S

cerebral venous sinus thrombosis

thrombocytopenia

pulmonary embolism

deep venous thrombosis

PF4 ELISA

IVIG treatment

COVID-19 vaccination

Thrombosis with Thrombocytopenia Syndrome

Thrombocytopenia

Ad26COV2S Vaccine

Transverse Sinus Thrombosis

D-dimer