Haematuria, a widespread petechial rash, and headaches following the Oxford AstraZeneca ChAdOx1 nCoV-19 Vaccination

With increasing presentations of headaches following COVID-19 vaccination, we present one of the UK’s earliest proven cases of vaccine-induced thrombotic thrombocytopaenia (VITT), with the aim of giving colleagues a case to compare other patients against. Our patient was a 48-year-old man who presented with frank haematuria, a widespread petechial rash, and headaches, 2 weeks after receiving the first dose of the Oxford AstraZeneca ChAdOx1 nCoV-19 vaccine. He had a platelet count of 14×109/L and an extensive cerebral venous sinus thrombosis (CVST) with subarachnoid haemorrhage on imaging. He developed localising neurological signs and experienced a cardiopulmonary arrest. He was successfully resuscitated and transferred to a tertiary care centre for urgent thrombectomy. This case illustrates how the diagnosis of VITT should be based on the platelet count and imaging—and how patients with VITT should be cared for in centres with urgent neurosurgical and interventional radiology services.

P053 Fulminant purpura in a patient with SARS-CoV-2

Background/Aims According to available data children with SARS-CoV-2 has asymptomatic or a milder clinical course, but there are known cases of multisystem inflammatory syndrome. Methods we observed a case of fulminant purpura in a boy with SARS-CoV-2. A three years old boy had febrile fever, vomiting, abdominal pain for no apparent reason. On the 2nd day this boy had joint pain, petechial rashes, fever and abdominal pain persisted. The patient was hospitalized in the pediatric Department, where he was diagnosed with hemorrhagic vasculitis, there was prescribed therapy with glucocorticosteroids (1 mg/kg per day), dipyridamole (2.5 mg/kg per day), oral cephalosporin. Against the background of ongoing therapy, the child's condition became worth. On the 5th day of the disease appeared necrosis in the area of the ankle joints, heels, and toes, patient was transferred to the pediatric Department of Children's Clinical Regional Hospital. Results at the time of hospitalization, the child's condition was severe: the boy had persistent high fever, petechial rash on the torso and legs, necrosis in the area of the left ankle, outer surface of the right ankle and in the area of both heels, edema of the feet and hands. The boy was in a forced position, couldn’t not walk and had intense pain in the shoulders, elbows, wrists, hips, knees and ankles. Blood tests revealed anemia (HGB 73 g/l), thrombocytopenia (PLT 120 x 109/L), leukocytosis (WBC 23 x 109/L), ESR 60 mm/h; in the clinical analysis of urine - proteinuria. In the blood test was detected significantly increased levels of CRP (129 mg/L), ferritin (637 ng/mL), triglycerides (1.39 mm/L), hypoproteinemia (48 g/L), hypoalbuminemia (31 g/L); the level of ALT, AST, LDH was normal. The level of D-dimer was 4792ng/mL, fibrinogen - 8.8 g/L, antithrombin III - 156%, protein C - 64%, coagulation Factor IX activity - 150 %, coagulation Factor VIII activity 289%. An increase of antinuclear antibodies, cardiolipins, phospholipids and ANCA were excluded. A nasopharyngeal swab was negative for SARS-CoV-2 (was made on the 5th day of the disease). On 14th illness day we detected IgM antibodies directed toward SARS-CoV-2 in this patient (IgG antibodies directed toward SARS-CoV-2 were absent). An echocardiogram showed no coronary artery abnormalities, echocardiogram was normal, a chest CT and MRI of the brain also were normal. The diagnosis was fulminant purpura in a patient with SARS-CoV-2. This boy received heparin, IVIG 2 g/kg, dexamethasone 10 mg per meter of body surface a day, antibiotic therapy was continued. As a result fever, petechial rash and necrosis regressed. After 4 weeks we detected IgG antibodies directed toward SARS-CoV. Conclusion the current case demonstrates the possibility of developing a multi-system inflammatory syndrome like fulminant purpura in patients who had SARS-CoV-2. Disclosure N. Tsurikova: None. S. Rodionocskaya: None. E. Ligostaeva: None. V. Avdeenko: None. N. Kobzeva: None. I. Tsiganok: None.

A Rash Diagnosis

This case presents a 16-year-old female with complaints of headache, abdominal pain, diarrhea, and vomiting who is brought to the emergency department by her parents. The emergency physician is struck by a petechial rash on the patient’s face, which triggers a vivid memory of a similar rash in a patient with meningococcemia that proved fatal. A lumbar puncture is quickly done, and antibiotics are initiated. The patient is subsequently transferred to another physician, who finds an alternate explanation for the patient’s symptoms and refers her to surgery.