Thrombocytopenia Secondary to COVID-19 Vaccination: Side Effect or Coincidence?

  While widespread coronavirus disease 2019 (COVID-19) vaccination has helped achieve some control of the pandemic, vaccines have presented with side effects of their own, both common and rare. We present an unusual case of a 66-year-old who presented with severe thrombocytopenia following vaccination with the Pfizer-BioNTech mRNA vaccine. Our patient is a 66-year-old African American female with a known history of Sjogren's syndrome and hepatitis C who presented to our facility as a direct admit from our affiliated infusion clinic where routine lab work revealed a platelet count of 14,000. On arrival, she reported a one-month history of progressive tiredness, intermittent epistaxis, and bruising on her legs. Her physical exam was notable for multiple petechiae and non-palpable purpura on all four extremities. Further questioning revealed that she had received her COVID-19 vaccine booster (Pfizer-BioNTech) three weeks prior to presentation and that is when all the symptoms had started. Rheumatology was consulted and the patient was started on intravenous immunoglobulin infusion for two days and pulse dose prednisone. Her platelet count showed improvement after treatment, and she was discharged home with a platelet count of 42,000. Though largely safe and efficacious, COVID-19 vaccines can present with rare systemic side effects and physicians must have a high index of suspicion and report these cases so that more data is available for interpretation.

Polymorphism of the renalase gene in gestational diabetes mellitus

Renalase is considered as a novel candidate gene for type 2 diabetes. In this study, we aimed to investigate the relationship of serum renalase and two single nucleotide polymorphisms with gestational diabetes mellitus. One hundred and ninety-eight normotensive pregnant females (n = 99 gestational diabetes mellitus; n = 99 euglycemic pregnant controls) were classified according to the International Association of the Diabetes and Pregnancy Study criteria. Fasting and 2-h post glucose load blood levels and anthropometric assessment was performed. Serum renalase was measured using enzyme-linked immunosorbent assay, whereas DNA samples were genotyped for renalase single nucleotide polymorphisms rs2576178 and rs10887800 using Polymerase chain reaction-Restriction fragment length polymorphism method. In an age-matched case control study, no difference was observed in the serum levels of renalase (p > 0.05). The variant rs10887800 showed an association with gestational diabetes mellitus and remained significant after multiple adjustments (p < 0.05), whereas rs2576178 showed weak association (p = 0.030) that was lost after multiple adjustments (p = 0.09). We inferred a modest association of the rs10887800 polymorphism with gestational diabetes. Although gestational diabetes mellitus is self-reversible, yet presence of this minor G allele might predispose to metabolic syndrome phenotypes in near the future.