{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T04:44:37Z","timestamp":1771994677781,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background and Objectives: Vaccine induced thrombotic thrombocytopenia (VITT) may occur after COVID-19 vaccination with recombinant adenoviral vector-based vaccines. VITT can present as cerebral sinus and venous thrombosis (CSVT), often complicated by intracranial hemorrhage. Today it is unclear, how long symptomatic VITT can persist. Here, we report the complicated long-term course of a VITT patient with extremely high titers of pathogenic anti-platelet factor 4 (PF4)-IgG antibodies. Methods: Clinical and laboratory findings are presented, including the course of platelet counts, D-Dimer levels, clinical presentation, imaging, SARS-CoV-2-serological and immunological, platelet activating anti-PF4-IgG, as well as autopsy findings. Results: The patient presented with extended superior sagittal sinus thrombosis with accompanying bifrontal intracerebral hemorrhage. Repeated treatment with intravenous immune globuline (IVIG) resolved recurrent episodes of thrombocytopenia. Moreover, the patient\u2019s serum remained strongly positive for platelet-activating anti-PF4-IgG over three months. After a period of clinical stabilization, the patient suffered a recurrent and fatal intracranial hemorrhage. Conclusions: Complicated VITT with extremely high anti-PF4-IgG titers over three months can induce recurrent thrombocytopenia despite treatment with IVIG and anticoagulation. Plasma exchange, immunoadsorption, and \/or immunosuppressive treatment may be considered in complicated VITT to reduce extraordinarily high levels of anti-PF4-IgG. Long-term therapy in such cases must take the individual bleeding risk and CSVT risk into account.<\/jats:p>","DOI":"10.3390\/vaccines9111344","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T21:32:07Z","timestamp":1637184727000},"page":"1344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Complicated Long Term Vaccine Induced Thrombotic Immune Thrombocytopenia\u2014A Case Report"],"prefix":"10.3390","volume":"9","author":[{"given":"Albrecht","family":"G\u00fcnther","sequence":"first","affiliation":[{"name":"Hans-Berger-Department of Neurology, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Br\u00e4mer","sequence":"additional","affiliation":[{"name":"Hans-Berger-Department of Neurology, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8157-2753","authenticated-orcid":false,"given":"Mathias W.","family":"Pletz","sequence":"additional","affiliation":[{"name":"Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Kamradt","sequence":"additional","affiliation":[{"name":"Core Facility Cytometry, Institute for Immunology, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8861-0388","authenticated-orcid":false,"given":"Sabine","family":"Baumgart","sequence":"additional","affiliation":[{"name":"Core Facility Cytometry, Institute for Immunology, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas E.","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3625-1544","authenticated-orcid":false,"given":"Michael","family":"Baier","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelina","family":"Autsch","sequence":"additional","affiliation":[{"name":"Forensic Medicine Department, Jena University Hospital, 07743 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Mawrin","sequence":"additional","affiliation":[{"name":"Forensic Medicine Department, Jena University Hospital, 07743 Jena, Germany"},{"name":"Department of Neuropathology, University Hospital Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Sch\u00f6nborn","sequence":"additional","affiliation":[{"name":"Department for Transfusion Medicine, Institute for Immunology and Transfusion Medicine, University Medicine Greifswald, 17487 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Greinacher","sequence":"additional","affiliation":[{"name":"Department for Transfusion Medicine, Institute for Immunology and Transfusion Medicine, University Medicine Greifswald, 17487 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0177-6508","authenticated-orcid":false,"given":"Thomas","family":"Thiele","sequence":"additional","affiliation":[{"name":"Department for Transfusion Medicine, Institute for Immunology and Transfusion Medicine, University Medicine Greifswald, 17487 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa2104840","article-title":"Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination","volume":"384","author":"Greinacher","year":"2021","journal-title":"N. 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