key: cord-0754651-q4t048if
authors: Lin, Chia-Yi; Wang, Ching-Hsiang; Hsiao, Po-Jen
title: Unusual Fever, Headache, and Abdominal Pain in a Healthy Woman
date: 2021-07-31
journal: Gastroenterology
DOI: 10.1053/j.gastro.2021.07.039
sha: 849e4ae53d63cd91759be8156aa74c639bbdaed4
doc_id: 754651
cord_uid: q4t048if

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To date, there is no literature in PubMed and Scopus focused on vaccine-induced hepatic vein thrombosis with occlusion (Budd-Chiari syndrome [BCS] ). This case report is the first of coronavirus disease 2019 (COVID-19) vaccine-induced immune thrombosis and thrombocytopenia (VITT) complicated by BCS. The pathophysiology of VITT is presumably the development of antibodies against PF4, resulting in platelet depletion with thrombocytopenia and thrombus formation. 1, 2 Treatments include intravenous immunoglobulin, methylprednisolone, and oral anticoagulants. 1, 2 The COVID-19 vaccines remain critical for the control of SARS-CoV-2; early diagnosis and management of VITT is imperative for physicians. The primary origin of BCS is usually in a pro-coagulant state resulting in venous thrombosis, whereas secondary cause can be associated extrinsic compression of the hepatic veins or tumor invasion. Clinical manifestations are varied greatly, from incidentally discovered asymptomatic thrombosis to fulminant liver failure. 3 Doppler ultrasound examination is the first-line key diagnostic tool, which is easily available, cost effective, and lacks ionizing radiation. It has a sensitivity and specificity of approximately 85% for the diagnosis of BCS. 3 A contrast-enhanced computed tomography scan is a commonly performed imaging study for BCS. It can help to delineate the vascular abnormality and evaluate the hepatic morphologic changes, as well as mapping the vascular anatomy before surgical interventions. 3

Keywords: ChAdOx1 COVID-19 (AstraZeneca) Vaccine; Platelet Factor 4 (PF4) Antibodies; Hepatic Vein Thrombosis; Budd-Chiari Syndrome. 233  234  235  236  237  238  239  240  241  242  243  244  245  246  247  248  249  250  251  252  253  254  255  256  257  258  259  260  261  262  263  264  265  266  267  268  269  270  271  272  273  274  275  276  277  278  279  280  281  282  283  284  285  286  287  288  289  290   291  292  293  294  295  296  297  298  299  300  301  302  303  304  305  306  307  308  309  310  311  312  313  314  315  316  317  318  319  320  321  322  323  324  325  326  327  328  329  330  331  332  333  334  335  336  337  338  339  340  341  342  343  344  345  346  347  348 

Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination

Therapeutic plasma exchange in vaccine-induced immune thrombotic thrombocytopenia

Budd-Chiari syndrome -various etiologies and imagistic findings. A pictorial review

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