Mount Sinai Beth Israel Medical Center New York, NY, United States
Michelle Shah, DO, Natasha Qureshi, MD, Gres Karim, MD, Urian Kim, MD, Violetta Laskova, MD, Frederick Rapoport, MD Mount Sinai Beth Israel Medical Center, New York, NY
Introduction: Superior mesenteric vein (SMV) thrombosis is a condition with low incidence but high mortality. It is well-known to occur in the setting of prothrombotic states such as malignancy, local abdominal inflammation, inherited or acquired coagulopathies, and myeloproliferative conditions secondary to JAK-2 mutation. We present a rare case of SMV thrombosis in a patient found to have antithrombin III deficiency with recent COVID-19 mRNA vaccination.
Case Description/Methods: A 67-year-old male with past medical history significant for hyperlipidemia and coronary artery disease presented to the emergency department with three days of intermittent lower abdominal pain radiating laterally in a band-like distribution with pressure and bloating sensation. On physical exam his abdomen was mildly distended but soft and non-tender with hypoactive bowel sounds. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed diffuse SMV thrombosis with extension of thrombus into the main and left hepatic portal veins. There was no clear intra-abdominal inflammatory process, no sign of infection or malignancy, and no history of inherited thrombophilia. Patient was started on therapeutic enoxaparin subcutaneously. Further history revealed that he received both doses of the Pfizer-BioNTech (BNT162b2) mRNA COVID-19 vaccine, with the second dose administered 75 days prior to admission. SARS CoV-2 IgG level was 69 AU/mL, which confirmed the presence of circulating IgG antibodies specific for SARS-CoV-2 at high levels. SARS-CoV-2 RNA was not detected on reverse-transcriptase–polymerase-chain-reaction assay of a nasopharyngeal swab. Lab work revealed low antithrombin III (AT III) at 69% and prolonged Russell’s Viper Venom test not corrected by phospholipid reagent.
Discussion: It is unclear if this patient’s low ATIII levels were in the setting of acute thrombosis, or if they were low prior to thrombus formation and secondary to circulating Covid-19 antibodies. There have been a few case reports of individuals with vaccine-induced immune-thrombotic thrombocytopenia (ITTP), deep vein thrombosis (DVT), and acquired hemophilia. It is important to bring awareness to uncommon adverse events that may be linked to COVID-19 mRNA vaccine administration so that providers and patients can be aware of the possibility of these events and not delay diagnosis and treatment.
Figure: Computed tomography (CT) of the abdomen and pelvis revealing diffuse SMV thrombosis with adjacent fat stranding.
Disclosures: Michelle Shah indicated no relevant financial relationships. Natasha Qureshi indicated no relevant financial relationships. Gres Karim indicated no relevant financial relationships. Urian Kim indicated no relevant financial relationships. Violetta Laskova indicated no relevant financial relationships. Frederick Rapoport indicated no relevant financial relationships.
Michelle Shah, DO, Natasha Qureshi, MD, Gres Karim, MD, Urian Kim, MD, Violetta Laskova, MD, Frederick Rapoport, MD. P0935 - A Rare Case of Superior Mesenteric Vein Thrombosis With Antithrombin III Deficiency and Recent COVID-19 mRNA Vaccination, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.