A Case of Immune Thrombocytopenic Purpura due to COVID-19 Vaccination that was Successfully Treated by Splenectomy

Abstract

There are several reports about immune thrombocytopenic purpura (ITP) as a rare complication following COVID-19 vaccination.

A 50-year-old woman had received COVID-19 vaccine twice for prevention of infection of severe acute respiratory syndrome corona virus. Two weeks after the second vaccination, she was referred to our hospital for hypermenorrhea with a low platelet count of 1,000/μL. The reticulocyte count increased, and the red blood cell count decreased. Bone-marrow examination revealed slightly increased megakaryocytes without atypia. Helicobacter pylori infection test was negative. Contrast-enhanced computed tomography revealed no obvious splenomegaly or collateral blood flow. The diagnosis was ITP and steroids (pulsed high-dose dexamethasone 40mg/day for four days and prednisolone 25mg/day) were administered. The platelet count was slightly elevated up to 2,000/μL and 5,000/μL after steroids, respectively. The steroids treatments were ineffective, and splenectomy was planned.

Gamma-globulin (20g/day for five days) and thrombopoietin were administered prior to splenectomy. However, the platelet count was 23,000/μL. She underwent laparoscopic splenectomy just after a platelet transfusion. She had an uneventful intra-and post-operative course. Two months later, the platelet count was as stable as 75,000/μL and the splenectomy was considered an effective treatment.

Splenectomy was a good option for ITP as a rare complication following COVID-19 vaccination.