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\begin{document}

\title{Severe superior mesenteric vein thrombosis after COVID-19 mRNA
vaccination}



\author[1]{Takahiro Kubo}%
\author[1]{Hideto Kawaratani}%
\author[1]{Hitoshi  Yoshiji}%
\affil[1]{Nara Medical University}%


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  \date{May 29, 2024}


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\begin{abstract}
Venous thrombosis rarely occurs in patients' after administered COVID-19
viral mRNA vaccination rather than vector vaccination. The occurrence of
superior mesenteric vein (SMV) is rarer. We herein present an image of
an SMV trunk thrombosis after COVID-19 mRNA vaccination.%
\end{abstract}%



\sloppy


\textbf{Severe superior mesenteric vein thrombosis after COVID-19 mRNA
vaccination}

Takahiro Kubo, Hideto Kawaratani, Hitoshi Yoshiji.

Running title

Severe SMV thrombosis after COVID-19 vaccination

Department of Gastroenterology, Nara Medical University, Japan

Takahiro Kubo,\emph{kubotaka@naramed-u.ac.jp}

Hideto Kawaratani MD. PhD.,\emph{kawara@naramed-u.ac.jp}

Hitoshi Yoshiji MD. PhD.,\emph{hyoshiji@naramed-u.ac.jp}

Correspondence to

Hideto Kawaratani MD. PhD.,

Department of Gastroenterology, Nara Medical University, Japan

840 Shijo-cho, Kashihara, Nara, Japan ZIP code 634-8522

Tel +81-744223051(ext 3415), Fax +81-744247122

E-mail: kawara@naramed-u.ac.jp

Key Words: COVID-19 mRNA vaccination, superior mesenteric vein
thrombosis

Abstract

Venous thrombosis rarely occurs in patients' after administered COVID-19
viral vector vaccination rather than mRNA vaccination. The occurrence of
superior mesenteric vein (SMV) is rarer. We herein present an image of
an SMV trunk thrombosis after COVID-19 mRNA vaccination.

An HIV-infected male patient in his 60s on antiretroviral therapy
presented to our hospital with upper abdominal pain one day after
coronavirus disease (2019) COVID-19 mRNA vaccination. The pain worsened
after seven days. Similarly, he experienced tenderness in the
pericardial region. Laboratory examination showed increased C reactive
protein and markedly elevated D-dimer levels. However, he had no
coagulation abnormalities, including JAK2 mutation and Protein S or C
deficiency. Contrast-enhanced computed tomography (CE-CT) showed
thrombosis in the main superior mesenteric vein (SMV) trunk and its
branches and thickened intestinal walls (Figure 1A, B). He was treated
with continuous unfractionated heparin for 3 weeks. During the
treatment, his symptom gradually improved. Three weeks later, CE-CT
showed thrombosis reduction, blood flow resumption, and wall thickness
reduction (Figure 2A, B). Subsequently, his treatment was switched to
apixaban, and he is currently undergoing therapy as an outpatient. The
major causes of SMV thrombosis include cirrhosis, malignancy,
intraabdominal infection, and coagulation abnormalities, such as JAK2
mutation and Protein S or C deficiency. However, this patient had none
of these risk factors. Thrombosis after COVID vaccination has gradually
become known in recent years; however, its frequency is not high.
Thrombosis occurs mainly with virus vector vaccination, and there are
only few such reports with mRNA vaccination. COVID-19 mRNA vaccination
reportedly increases the risk of venous thromboembolism by
1.16-fold.{[}1{]} The occurrence of venous thrombosis is considered more
common among young women. In addition, there are only two reports of SMV
thrombosis,{[}2, 3{]} and hence, this case should be reported. When a
patient develops abdominal pain after COVID-19 mRNA vaccination, SMV
thrombosis should be considered as one of the differential diagnoses. We
present this case because of its novel clinical findings and to increase
awareness among gastroenterologists.

Refarence 1. Klein NP, Lewis N, Goddard K, et al. Surveillance for
adverse events after COVID-19 mRNA vaccination. \emph{JAMA}
2021;326:1390-9. 2. Umbrello M, Brena N, Vercelli R, et al. Successful
treatment of acute spleno-porto-mesenteric vein thrombosis after ChAdOx1
nCoV-19 vaccine. A case report. \emph{J Crit Care} 2021;65:72-5.

3. Gra\selectlanguage{ngerman}ça LL, Amaral MJ, Serôdio M, et al. Extensive thrombosis after
COVID-19 vaccine: cause or coincidence? \emph{BMJ Case
Rep}2021;14:e244878.

Figure legends

Figure 1. Contrast-enhanced computed tomography shows thrombosis in the
superior mesenteric vein trunk and its branches (arrow) and thickened
intestinal walls (arrowhead). (A) axial view. (B) coronal view.

Figure 2. Contrast-enhanced computed tomography shows improvements in
thrombosis in the superior mesenteric vein (arrow) and thickened
intestinal walls. (A) axial view. (B) coronal view.

AUTHOR CONTRIBUTIONS

Conception of case report: Takahiro Kubo. Drafting of case report:
Takahiro Kubo and Hideto Kawaratani. Revision and final approval of case
report: Hideto Kawaratani and Hitoshi Yoshiji.

ACKNOWLEDGMENT

None

CONFLICT OF INTEREST

None.

ETHICAL APPROVAL

All procedures performed were in accordance with the ethical standards.

CONSENT

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/suraido1/suraido1}

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\end{figure}\selectlanguage{english}
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