Vaccination with an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in the rare development of thrombosis with thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4). This is a life-threating condition that may be accompanied by bleeding due to thrombocytopenia with thrombosis of the cerebral venous sinus or splanchnic vein. Herein, we describe the first fatal case of thrombosis with thrombocytopenia syndrome in Korea, presenting with intracranial hemorrhage caused by cerebral venous sinus thrombosis. A 33-year-old Korean man received the first dose of the ChAdOx1 nCoV-19 vaccination. He developed severe headache with vomiting 9 days after the vaccination. Twelve days after vaccination, he was admitted to the hospital with neurological symptoms and was diagnosed with cerebral venous sinus thrombosis, which was accompanied by intracranial hemorrhage. Thrombocytopenia and D-dimer elevation were observed, and the result of the PF4 enzyme-linked immunosorbent assay antibody test was reported to be strongly positive. Despite intensive treatment, including intravenous immunoglobulin injection and endovascular mechanical thrombectomy, the patient died 19 days after vaccination. Physicians need to be aware of thrombosis with thrombocytopenia syndrome (TTS) in adenoviral vector-vaccinated patients. Endovascular mechanical thrombectomy might be a useful therapeutic option for the treatment of TTS with cerebral venous sinus thrombosis.

中文翻译：

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接种 COVID-19 疫苗后因血栓形成伴血小板减少综合征导致脑出血：韩国首例死亡病例。


接种针对严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的腺病毒载体疫苗可能会导致罕见的血栓形成，并伴有抗血小板因子 4 (PF4) 的血小板激活抗体介导的血小板减少症。这是一种危及生命的疾病，可能伴有血小板减少导致的出血，并伴有脑静脉窦或内静脉血栓形成。在此，我们描述了韩国首例因血栓伴血小板减少综合征而死亡的病例，表现为脑静脉窦血栓形成引起的颅内出血。一名 33 岁的韩国男子接受了第一剂 ChAdOx1 nCoV-19 疫苗接种。接种疫苗后 9 天，他出现严重头痛并伴有呕吐。接种疫苗12天后，他因神经症状入院，诊断为脑静脉窦血栓，并伴有颅内出血。观察到血小板减少和D-二聚体升高，PF4酶联免疫吸附试验抗体检测结果报告为强阳性。尽管进行了包括静脉注射免疫球蛋白和血管内机械血栓切除术在内的强化治疗，患者还是在接种疫苗后 19 天死亡。医生需要了解腺病毒载体疫苗接种患者的血栓形成伴血小板减少综合征（TTS）。血管内机械血栓切除术可能是治疗伴有脑静脉窦血栓形成的 TTS 的有效治疗选择。