RESUMEN
Vaccine-induced thrombotic thrombocytopenia with cerebral venous thrombosis is a syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine. Here we report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia 9-10 days following ChAdOx1 nCoV-19 vaccination. The two cases arrived in our facility around the same time but from different geographical areas, potentially excluding epidemiological links; meanwhile, no abnormality was found in the respective vaccine batches. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two prior, successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both patients manifested pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes. None of the patients had ever received heparin in the past before stroke onset. Our observations of rare arterial thrombosis may contribute to assessment of possible adverse effects associated with COVID-19 vaccination.
Asunto(s)
Vacunas contra la COVID-19/efectos adversos , COVID-19/inmunología , Infarto Cerebral/inducido químicamente , Púrpura Trombocitopénica Idiopática/inducido químicamente , SARS-CoV-2/inmunología , Trombosis/inducido químicamente , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , COVID-19/virología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/inmunología , Infarto Cerebral/diagnóstico por imagen , ChAdOx1 nCoV-19 , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Factor Plaquetario 4/inmunología , Púrpura Trombocitopénica Idiopática/diagnóstico por imagen , SARS-CoV-2/fisiología , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Vacunación/efectos adversos , Trombosis de la Vena/inducido químicamente , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Mesenchymal cystic hamartoma (MCH) of the lung is a rare disease, with an indolent course in the majority of cases. It can be single or multifocal and it is composed of primitive mesenchymal cells admixed with cystic spaces. Only few cases have been reported in the literature, with variable clinical presentation. We describe the case of a huge MCH, presenting with spontaneous pneumothorax in a 65-year-old man. Further, we provide a brief overview of the literature and discuss the differential diagnosis with other entities, and the possible diagnostic pitfalls.