# Immune Thrombocytopenia After COVID-19 Vaccine Requiring Splenectomy: A Case Report and Review of the Literature

## TL;DR

A rare case of severe immune thrombocytopenia after a first dose of a COVID-19 vaccine led to a splenectomy, highlighting the need for careful monitoring and individualized treatment.

## Contribution

This is the fourth documented case of severe ITP requiring splenectomy after a first dose of a COVID-19 vaccine.

## Key findings

- The patient developed ITP two weeks after the first dose of a COVID-19 vaccine.
- The patient relapsed after receiving the second dose from a different vaccine manufacturer.
- Splenectomy was required to achieve complete remission due to refractory ITP.

## Abstract

Post-vaccination immune thrombocytopenia (ITP) is a rare but recognized adverse event believed to result from an autoimmune reaction triggered by the vaccine. This case report presents the fourth documented instance of severe ITP requiring splenectomy following the administration of a COVID-19 vaccine. The patient, a 54-year-old previously healthy female with no familial history of autoimmune or hematological disorders, developed ITP two weeks after the first dose of the COVID-19 vaccine. While most ITP cases associated with COVID-19 vaccines manifested after the second dose, this unique case demonstrated symptoms following the initial vaccination. Initially responsive to first-line management, the patient experienced a relapse upon receiving the second dose from a different vaccine manufacturer. Despite exhaustive medical interventions, the refractory nature of the condition persisted, ultimately mandating splenectomy for the achievement of complete remission. This case underscores the potential for serious, refractory ITP with the second dose of a COVID-19 vaccine, particularly in patients who initially developed ITP after the first dose, even if they had seemingly achieved complete remission. These findings emphasize the importance of vigilant monitoring and individualized treatment strategies in such cases, contributing valuable insights to the growing body of knowledge surrounding vaccine-induced ITP.