Immune Thrombocytopenia Relapse in Patients Who Received mRNA COVID-19 Vaccines.

Background: Immune thrombocytopenia (ITP) is a blood disorder in which antibodies coating platelets cause platelet destruction in the spleen with a resultant low platelet count and an increased tendency for bleeding. Coronavirus disease 2019 (COVID-19) is an illness caused by SARS-CoV-2. Though pneumonia and respiratory failure are major causes of morbidity and mortality, multisystemic complications were identified, including hematological ones. Several ITP relapse cases post-mRNA SARS-CoV-2 vaccines have been reported, and different pathophysiological theories have been proposed. Purpose: The objective of this study is to identify the causal relationship between mRNA COVID-19 vaccines and ITP relapse, to highlight the longer-term effect of these vaccines on the platelet count more than 6 months after receiving the vaccine, and to identify if there is a statistical difference between Comirnaty and Spikevax vaccines on ITP relapse rate. Patients and Methods: In this retrospective study, 67 patients with known ITP were followed before and after receiving the mRNA COVID-19 vaccine. The follow-up parameters included platelet counts when available and bleeding symptoms. All patients were adults over 18 years old, with no other identified causes of thrombocytopenia. Forty-seven patients received the Comirnaty vaccine, and 20 patients received the Spikevax vaccine. Results: Data analysis showed 6% ITP relapse in the first 3 months, and a 10% relapse rate 3-6 months after receiving one of the mRNA COVID-19 vaccines, with no statically significant difference between the two vaccines. Conclusion: mRNA COVID-19 vaccines increase the risk of ITP relapse and can lead to a prolonged reduction in platelet count in a proportion of ITP patients, with no statistically significant difference between Comirnaty and Spikevax vaccines.

Intracranial Hemorrhage Associated With Listeria monocytogenes Bacteremia in an Elderly Patient on Mycophenolate Mofetil.

Listeria monocytogenes is an important foodborne bacterial pathogen in immunosuppressed patients, pregnant women, and individuals at the extremes of age, including neonates and older adults. Invasion of the central nervous system (CNS) and bacteremia are the principal clinical manifestations of infection in these hosts. In contrast, normal hosts who ingest high numbers of Listeria may develop self-limited febrile gastroenteritis. Hydrocephalus and intracranial hemorrhage (ICH) are very rare and severe complications of L. monocytogenes infection. ICH associated with L. monocytogenes has been reported even less frequently than hydrocephalus, with most cases occurring in the pediatric population. In this paper, we present a case of L. monocytogenes bacteremia in a 71-year-old male, complicated by intracranial hemorrhage. He presented at first with nonspecific symptoms of generalized weakness and fatigability and later developed drowsiness, disorientation, and fever, which prompted further investigations that revealed the presence of ICH and L. monocytogenes bacteremia.