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Geeraerts T, Guilbeau-Frugier C, Garcia C, Memier V, Raposo N, Bonneville F, Gales C, Darcourt J, Voisin S, Ribes A, Piel-Julian M, Bounes F, Albucher JF, Roux FE, Izopet J, Telmon N, Olivot JM, Sié P, Bauer J, Payrastre B, Liblau RS. Immunohistologic Features of Cerebral Venous Thrombosis Due to Vaccine-Induced Immune Thrombotic Thrombocytopenia. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200127. [PMID: 37236806 DOI: 10.1212/nxi.0000000000200127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/05/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Vaccine-induced immune thrombotic thrombocytopenia (VITT), a recently described entity characterized by thrombosis at unusual locations such as cerebral venous sinus and splanchnic vein, has been rarely described after adenoviral-encoded COVID-19 vaccines. In this study, we report the immunohistological correlates in 3 fatal cases of cerebral venous thrombosis related to VITT analyzed at an academic medical center. METHODS Detailed neuropathologic studies were performed in 3 cases of cerebral venous thrombosis related to VITT after adenoviral COVID-19 vaccination. RESULTS Autopsy revealed extensive cerebral vein thrombosis in all 3 cases. Polarized thrombi were observed with a high density of neutrophils in the core and a low density in the tail. Endothelial cells adjacent to the thrombus were largely destroyed. Markers of neutrophil extracellular trap and complement activation were present at the border and within the cerebral vein thrombi. SARS-CoV-2 spike protein was detected within the thrombus and in the adjacent vessel wall. DISCUSSION Data indicate that neutrophils and complement activation associated with antispike immunity triggered by the vaccine is probably involved in the disease process.
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Affiliation(s)
- Thomas Geeraerts
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Céline Guilbeau-Frugier
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Cédric Garcia
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Vincent Memier
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Nicolas Raposo
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Fabrice Bonneville
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Céline Gales
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jean Darcourt
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Sophie Voisin
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Agnès Ribes
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Marie Piel-Julian
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Fanny Bounes
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jean François Albucher
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Franck-Emmanuel Roux
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jacques Izopet
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Norbert Telmon
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jean Marc Olivot
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Pierre Sié
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Jan Bauer
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Bernard Payrastre
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France
| | - Roland S Liblau
- From the Department of Anesthesiology and Critical Care (T.G., F. Bounes); Department of Forensic Medicine (C.G.-F., C. Gales, N.T.), Toulouse University Hospital; Institute of Metabolic and Cardiovascular Diseases (C. Garcia, A.R., B.P.), Inserm UMR-1297; Hematology Laboratory (C. Garcia, V.M., S.V., A.R., P.S., B.P.); Department of Neurology (N.R., J.F.A., J.M.O.); Department of Neuroradiology (F. Bonneville, J.D.); Department of Internal Medicine (M.P.-J.); Department of Neurosurgery (F.R.); Department of Virology (J.I.), Toulouse University Hospital, France; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L.), Toulouse University Hospital, France.
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