Fatal Intracerebral Hemorrhage Linked to AstraZeneca COVID-19 Vaccine in Pregnant Woman

A 35-year-old pregnant woman developed an atypical intracerebral hemorrhage and central venous sinus thrombosis associated with vaccine-induced thrombotic thrombocytopenia twelve days after receiving the ChAdOx1 nCoV-19 vaccine, according to a case report published in Cureus and detailed in public health documentation from the National Institutes of Health’s PubMed Central repository.

Clinical Presentation and Vaccine Timeline

The patient, who was 23 weeks pregnant and managing controlled hypothyroidism due to Hashimoto’s disease, received her first dose of the Oxford-AstraZeneca ChAdOx1 nCoV-19 vaccine in late April 2021, according to PMC data. On the day following her vaccination, she experienced minor symptoms including malaise, chills, tremors, and a cold feeling. She subsequently developed a generalized skin rash across her legs, abdomen, and back that resolved on its own, as noted in the medical records.

Routine prenatal examinations on day three identified a urinary tract infection caused by Morganella morganii, which physicians treated with trimethoprim-sulfamethoxazole. A complete blood count conducted at that time showed a platelet count of 148,000 per cubic millimeter, which sits within normal parameters. By day seven, however, the patient reported experiencing a headache, nausea, general malaise, polaciuria, and pain in her lower limbs and hips. Although her platelet count had dropped to 121,000 per cubic millimeter, emergency obstetric staff provided analgesics and discharged her.

Hospitalization and Diagnostic Findings

The patient maintained a persistent headache and bilateral leg pain over the following days that responded only partially to dipyrone. On day eleven, she reported a severe headache localized in the left maxillary region. She returned to the hospital on day twelve presenting with an excruciating headache and a sharp decline in platelets to 33,000 per cubic millimeter, according to the PMC case documentation.

During a computed tomography scan, the patient became comatose, requiring immediate endotracheal intubation. This emergency intervention prevented physicians from performing a cerebral venography to confirm the suspected central venous sinus thrombosis. The brain CT scan revealed a large acute intraparenchymal hematoma measuring approximately 10.1 by 5.4 by 5.5 centimeters located in the left temporal lobe, insula, and temporoparietal transition of the left cerebral hemisphere.

The hematoma was surrounded by vasogenic edema accompanied by a midline shift to the right, herniation of the uncus, a marked compressive effect on the midbrain, and subtotal collapse of the supratentorial ventricular system, according to the published findings. Hospital staff administered platelet concentrate as part of her emergency management.

Broader Context of VITT and Pregnancy

The ChAdOx1 nCoV-19 vaccine consists of a replication-deficient chimpanzee adenoviral vector containing the SARS-CoV-2 structural surface glycoprotein spike antigen gene, as outlined in clinical background data. While initial clinical trials involving 23,848 participants detected no signal for increased thrombotic events, the vaccine has since been administered to more than 34 million people globally, with approximately 20.8 million doses applied in Brazil.

The vaccine has been linked to vaccine-induced thrombotic thrombocytopenia, a rare but serious adverse event characterized by thrombocytopenia and thrombosis in unusual anatomical sites such as cerebral venous or splanchnic-vein thrombosis. The estimated incidence of VITT is roughly one case per 100,000 vaccine exposures, driven by the formation of anti-heparin/platelet factor 4 antibodies that resemble heparin-induced thrombocytopenia despite the absence of heparin exposure. Clinical trials did not originally include pregnant women, though public health data indicates that pregnant patients infected with SARS-CoV-2 face higher risks of mortality and intensive care admission compared to non-pregnant persons of reproductive age.