Thrombosis with Thrombocytopenia Syndrome (TTS) After ChAdOx1 nCoV-19 Immunization: An Investigative Case Report

Nityanand Jain (Coresponding Author), Piyush Chaudhary, Amit Shrivastava, Taranvir Kaur, Shabjot Kaur, Harmandeep Singh Brar, Ravul Jindal (Coresponding Author)

Research output: Contribution to journalArticlepeer-review


Thrombosis with thrombocytopenia syndrome (TTS) including vaccine-induced immune thrombotic thrombocytopenia (VITT) is an extremely rare side-effect mostly seen post-initial vaccination with viral vector-based AstraZeneca-Oxford COVID-19 vaccine. It is characterized by mild to severe thrombocytopenia and venous or arterial thrombosis.

Case Report:
Herein, we present a case of an 18-year-old young male patient who developed Level 1 TTS (probable VITT) eight days post-immunization with ChADOx1 nCOV-19 vaccine (Covishield; AZ-Oxford). Initial investigations revealed severe thrombocytopenia, hemiparesis, and intracranial haemorrhage, following which patient was treated conservatively. However, a decompressive craniotomy was performed later due to patient deterioration. A week post-surgery, the patient developed bilious vomiting, lower gastrointestinal bleeding, and abdominal distension. An abdominal CT scan was performed that showed thrombosis of the portal vein with occlusion of the left iliac vein. The patient underwent an exploratory laparotomy followed by resection and anastomosis of the small bowel due to massive gut gangrene. Due to persistent thrombocytopenia post-surgery, intravenous immune globulin (IVIG) was administered. The platelet count increased thereafter, and the patient stabilized. The patient was discharged on the 33rd day since admission and followed up for one year. No post-hospitalization complications were observed in the follow-up period.

Although vaccines have been proven to be highly safe and effective to end the Coronavirus Disease 2019 (COVID-19) pandemic, there is still a small risk of developing rare complications including TTS and VITT. Early diagnosis and prompt intervention are key for patient management.
Original languageEnglish
JournalAmerican Journal of Case Reports
Publication statusE-pub ahead of print - 13 Feb 2023


  • ChAdOx1 nCoV-19
  • COVID-19 Vaccines
  • Immunoglobulins
  • Thrombocytopenia
  • Venous thrombosis
  • Headache

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.4. Reviewed scientific article published in Latvia or abroad in a scientific journal with an editorial board (including university editions)


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