- 期刊
新冠病毒疫苗引起的免疫血栓性血小板減少症：病例報告
Covid-19 Vaccine-Induced Immune Thrombocytopenia and Thrombosis: A Case Report
摘要
新冠病毒疫苗誘導的免疫血栓性血小板減少症是一個相對較新的臨床症狀。此報告為施打阿斯特捷利康（AstraZeneca, ChAdOx1 nCoV-19，以下簡稱AZ）疫苗後出現免疫血栓性血小板減少症致死個案。此個案為33歲健康男性沒有疾病史，施打AZ疫苗第十天後出現胸悶、胸痛、喘症狀。至醫院急診就醫，初步診斷為心肌梗塞併有疑似AZ疫苗引起的免疫血栓性血小板減少症，收入加護病房治療。經影像學檢查後，發現在心、肺、腹部與腦部有血栓形成，故給予免疫球蛋白、血漿置換術與開顱減壓術。術後仍有嚴重的腦充血、腫脹和梗塞，致使病患臨床呈現腦死狀態，於住院第20天死亡。此病例雖然很少發生，但隨著疫苗施打愈來愈普及，我們應重視疫苗接種後所帶來的併發症。本結果可以提供重要資訊以期能達到儘早診斷與治療為目的。
並列摘要
Immune thrombotic thrombocytopenia induced by COVID-19 vaccine is a relatively new clinical symptom. This report demonstrated that a case had immune thrombotic thrombocytopenia after receiving AZ vaccine and died after treatment. This case was a healthy man at the age of 33 years without history of diseases. He showed persistent chest pain and shortness of breath at the 10th day after receiving AZ vaccine. At the emergency department, he was preliminarily diagnosed with myocardial infarction and immune thrombotic thrombocytopenia possibly induced by AZ vaccine. He was admitted to the intensive care unit for treatment. Imaging diagnosis showed thrombosis in the pulmonary arteries, heart, abdomen, and brain. He was treated with intravenous immunoglobulin replacement therapy, plasma exchange, and decompressive craniectomy. After treatment, his clinical condition deteriorated rapidly, including severe brain swelling and infarction, and impending brain death. He was died at the 20^(th) days after admission. Although this symptom rarely occurs, immune thrombocytopenia and thrombosis complications induced by COVID-19 vaccine should not be ignored due to broad vaccination coverage. We hope that this result could provide important information for the purpose of early diagnosis and early treatment.