Reactions 1871, p132 - 4 Sep 2021

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Reactions 1871, p132 - 4 Sep 2021

COVID-19 Vaccine Pfizer BioNTech

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Soreness at injection site and cerebral venous sinus thrombosis: case report

A 49-year-old man developed soreness at injection site and cerebral venous sinus thrombosis (VST) following administration of COVID-19 Vaccine Pfizer BioNTech.

The man had a history of childhood asthma and allergy to seafood and nonsteroidal medication. He had undergone transluminal coronary angioplasty 3 years previously for single-vessel coronary artery disease. He had been receiving dual antiplatelet therapy and was non compliant. On 1 March 2021, he received the first dose of SC COVID-19 Vaccine Pfizer BioNTech [EP2163, Pfizer/

BioNTech]. He developed injection site soreness and myalgia of 24h duration. On 17 March 2021, he developed a new-onset mild to moderate headache and giddiness; it remained persistent. The symptoms necessitated hospital visit on 21 March 2021.

Laboratory tests revealed the following: platelet count 302 × 10⁹/L, international normalised ratio 0.98, prothrombin time 13s, activated partial thromboplastin time 38s and D-dimer 0.2. A non-contrast brain CT showed cordlike hyperattenuation in the left transverse and sigmoid sinus suggesting, cord or dense clot sign. Subsequently, on 22 March 2021, he received the second dose of COVID-19 Vaccine Pfizer BioNTech [EP9605, Pfizer/BioNTech]. His symptoms however remained persistent and even worsened.

Therefore, he underwent CT cerebral venography after 2 days. The CT scan findings revealed a long segment-filling defect and empty delta sign within the superior sagittal sinus extending into the torcula Herophili, left transverse sinus and sigmoid sinus to proximal internal jugular vein. The diagnosis of cerebral VST was made; it was attributed to COVID-19 Vaccine Pfizer BioNTech.

The man started receiving enoxaparin sodium [Clexane] and clopidogrel, resulting in gradual improvement of the symptoms.

Subsequent CT cerebral venogram after 2 weeks showed residual cerebral VST. In addition, filling defects within the proximal section of the superior sagittal sinus, left transverse sinus and left sigmoid sinus were also present. Furthermore, opacification were visualised at the distal part of the superior sagittal sinus, torcula Herophili and left internal jugular vein. Subsequently, enoxaparin sodium was switched to apixaban.

Zakaria Z, et al. Cerebral venous sinus thrombosis 2 weeks after the first dose of mRNA SARS-CoV-2 vaccine. Acta Neurochirurgica 163: 2359-2362, No. 8, Aug 2021.

Available from: URL: http://doi.org/10.1007/s00701-021-04860-w 803592889