Púrpura trombocitopénica autoinmune tras vacunación contra el mRNA-SARS-CoV-2: un reporte de caso
DOI:
https://doi.org/10.15649/cuidarte.3799Palabras clave:
COVID-19, SARS-CoV-2, Vacunas de ARNm, Púrpura Trombocitopénica Autoinmune, PlaquetasResumen
Introducción: Este reporte presenta el caso de un paciente colombiano adulto, de sexo masculino, sin antecedentes de trombocitopenia ni trastornos hematológicos, que desarrolló una púrpura trombocitopénica autoinmune paucisintomática leve y crónica, una rara complicación posterior a la vacunación con ARNm contra el virus SARS-CoV-2. Hasta donde se sabe, este es el primer caso documentado en Colombia de púrpura trombocitopénica autoinmune asociada al uso de vacunas de ARNm (BNT162b2 o ARNm-1273), con un seguimiento clínico integral de 2 años. Descripción del caso: El paciente recibió la primera y segunda dosis de la vacuna de ARNm BNT162b2 en junio de 2021, la primera dosis de refuerzo en noviembre de 2021 (ARNm-1273) y la segunda dosis de refuerzo (ARNm BNT162b2) en junio de 2022. Se documentó trombocitopenia (<100 x109 plaquetas/L, que es el criterio para definir la púrpura trombocitopénica autoinmune) tras la segunda dosis y ambos refuerzos. El paciente mejoró luego del tratamiento con corticosteroides, pero la trombocitopenia cíclica persistió hasta el seguimiento clínico en agosto de 2023, con un recuento de plaquetas que oscilaba entre 57 y 191 x109 plaquetas/L (media: 103x109 plaquetas/L). Conclusión: Dado que la púrpura trombocitopénica autoinmune puede producirse tras la vacunación con ARNm contra el virus SARS-CoV-2, es necesaria una investigación sistemática para identificar los factores de riesgo asociados a la púrpura trombocitopénica autoinmune debida a la inmunización contra la COVID-19.
Como citar este artículo: Lozada Ramos Heiler, Martínez-Vega Ruth Aralí, García Liliana Torcoroma. Immune thrombocytopenic purpura following mRNA-SARS-CoV-2 vaccination: A case report. Revista Cuidarte. 2024;15(2):e3799. https://doi.org/10.15649/cuidarte.3799
Referencias
Instituto Nacional de Salud. Situación COVID-19. Boletín Epidemiológico Semanal. 2023;52:17. https://doi.org/10.33610/23576189.2023.52
World Health Organization 2023 data.who.int. WHO Coronavirus (COVID-19) dashboard >Vaccines [Internet]. Ginebra: WHO. [cited 2024 May 11]. Available from: https://data.who.int/dashboards/covid19/vaccines
Alshammari F, Abuzied Y, Korairi A, Alajlan M, Alzomia M, AlSheef M. Bullous pemphigoid after the second dose of mRNA- (Pfizer-BioNTech) Covid-19 vaccine: A case report. Ann Med Surg (Lond). 2022;75:103420. https://doi.org/10.1016/j.amsu.2022.103420
Hagihara M, Uchida T, Inoue M, Ohara S, Imai Y. Severe thrombocytopenia after COVID-19 mRNA vaccination. Rinsho Ketsueki. 2021;62(12):1684-1687. https://doi.org/10.11406/rinketsu.62.1684
King ER, Towner E. A Case of Immune Thrombocytopenia After BNT162b2 mRNA COVID-19 Vaccination. Am J Case Rep. 2021;22:e931478. https://doi.org/10.12659/AJCR.931478
Leone MC, Canovi S, Pilia A, Casali A, Depietri L, Fasano T, et al. Four cases of acquired hemophilia A following immunization with mRNA BNT162b2 SARS-CoV-2 vaccine. Thromb Res. 2022;211:60-62. https://doi.org/10.1016/j.thromres.2022.01.017
Sato K, Anayama M, Sumi M, Kobayashi H. Immune thrombocytopenia after BNT162b2 mRNA COVID-19 vaccination. Rinsho Ketsueki. 2021;62(12):1688-1693. https://doi.org/10.11406/rinketsu.62.1688
Kuter DJ. The treatment of immune thrombocytopenia (ITP): focus on thrombopoietin receptor agonists. Ann Blood. 2021;6:7. http://dx.doi.org/10.21037/aob-21-23
Neylon AJ, Saunders PW, Howard MR, Proctor SJ, Taylor PR, Northern Region Haematology Group. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol. 2003;122:966-74. https://doi.org/10.1046/j.1365-2141.2003.04547.x
Lo E, Deane S. Diagnosis and classification of immune-mediated thrombocytopenia. Autoimmun Rev. 2014;13:577-83. https://doi.org/10.1016/j.autrev.2014.01.02
Lozada Ramos H, Martínez-Vega R, García LT. A case report of de novo immune thrombocytopenic purpura (ITP) following COVID-19-mRNA vaccination: 2-year clinical follow up. Mendeley Data, V2. 2024. https://doi.org/10.17632/wvdxt4r9yw.2
Waxman JG, Makov-Assif M, Reis BY, Netzer D, Balicer RD, Dagan N, et al. Comparing COVID-19-related hospitalization rates among individuals with infection-induced and vaccine-induced immunity in Israel. Nat Commun. 2022;13:2202. https://doi.org/10.1038/s41467-022-29858-5
Alameh MG, Weissman D, Pardi N. Messenger RNA-based vaccines against infectious diseases. Yu D, Petsch B. (eds) mRNA Vaccines. Curr Top Microbiol Immunol. 2022;440:111-145. https://doi.org/10.1007/82_2020_202
Sharif N, Alzahrani KJ, Ahmed SN, Dey SK. Efficacy, immunogenicity, and safety of COVID-19 vaccines: a systematic review and meta-analysis. Front Immunol. 2021;12:714170. https://doi.org/10.3389/fimmu.2021.714170
Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019;381:945-955. https://doi.org/10.1056/NEJMcp1810479
Sivaramakrishnan P, Mishra M. Vaccination-associated immune thrombocytopenia possibly due to ChAdOx1 nCoV-19 (Covishield) coronavirus vaccine. BMJ Case Rep. 2022;15:e249237. https://doi.org/10.1136/bcr-2022-249237
Bidari A, Asgarian S, Pour Mohammad A, Naderi D, Anaraki SR, Gholizadeh Mesgarha M, et al. Immune thrombocytopenic purpura secondary to COVID‐19 vaccination: A systematic review. Eur J Haematol. 2023;110:335-353. https://doi.org/10.1111/ejh.13917
Saluja P, Amisha F, Gautam N, Goraya H. A Systematic Review of Reported Cases of Immune Thrombocytopenia after COVID-19 Vaccination. Vaccines. 2022;10(9):1444. https://doi.org/10.3390/vaccines10091444
Malayala SV, Mohan G, Vasireddy D, Atluri P. Purpuric rash and thrombocytopenia after the mRNA-1273 (Moderna) COVID-19 vaccine. Cureus. 2021;13(3):e14099. https://doi.org/10.7759/cureus.14099
Inagaki N, Kibata K, Tamaki T, Shimizu T, Nomura S. Prognostic impact of the mean platelet volume/platelet count ratio in terms of survival in advanced non-small cell lung cancer. Lung Cancer. 2014;83(1):97-101. https://doi.org/10.1016/j.lungcan.2013.08.020
O'Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT, et al. Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):333-345. https://doi.org/10.1053/j.gastro.2017.06.065
Mohamed I, Abbas R, Amer A, Hassan E. Platelet/lymphocyte ratio (PLR) predictive value in immune thrombocytopenic purpura patients. Ain Shams Med J. 2023;74(1):13-20. https://doi.org/10.21608/ASMJ.2023.298369
Wang LH, Chen C, Wang Q, Song J, Cao J, Guo PX. Platelet to Lymphocyte Ratio and Glucocorticoid Resistance in Newly Diagnosed Primary Immune Thrombocytopenia: A Retrospective Cohort Study. Med Sci Monit. 2019;25:7321-7331. https://doi.org/10.12659/MSM.916907
Augène E, Lareyre F, Chikande J, Guidi L, Ballaith A, Bossert JN, et al. Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS One. 2019;14(7):e0219763. https://doi.org/10.1371/journal.pone.0219763
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