Adenovirus-Associated Thrombocytopenia, Thrombosis, and VITT-like Antibodies

This Correspondence reports a novel anti–platelet factor 4 (PF4) disorder resembling vaccine-induced immune thrombotic thrombocytopenia (VITT), triggered not by vaccination but by adenovirus infection. Two patients—a 5-year-old boy and a 58-year-old woman—developed symptomatic adenovirus infection, followed by severe thrombocytopenia, coagulopathy, and thrombosis (cerebral venous sinus thrombosis and multiple arterial and venous events, respectively). Laboratory assays confirmed VITT-like anti-PF4 antibodies with distinct serologic profiles and epitope mapping indicating binding to the heparin-binding region of PF4. Neither had prior heparin exposure. These findings expand the spectrum of anti-PF4 disorders and suggest that adenovirus alone may rarely provoke a life-threatening immune prothrombotic syndrome resembling VITT. The authors emphasize the importance of prompt diagnosis via PF4 antibody testing and recommend treatment strategies modeled after VITT, including anticoagulation, immune globulin, and plasma exchange.

This Correspondence reports a novel anti–platelet factor 4 (PF4) disorder resembling vaccine-induced immune thrombotic thrombocytopenia (VITT), triggered not by vaccination but by adenovirus infection. Two patients—a 5-year-old boy and a 58-year-old woman—developed symptomatic adenovirus infection, followed by severe thrombocytopenia, coagulopathy, and thrombosis (cerebral venous sinus thrombosis and multiple arterial and venous events, respectively). Laboratory assays confirmed VITT-like anti-PF4 antibodies with distinct serologic profiles and epitope mapping indicating binding to the heparin-binding region of PF4. Neither had prior heparin exposure. These findings expand the spectrum of anti-PF4 disorders and suggest that adenovirus alone may rarely provoke a life-threatening immune prothrombotic syndrome resembling VITT. The authors emphasize the importance of prompt diagnosis via PF4 antibody testing and recommend treatment strategies modeled after VITT, including anticoagulation, immune globulin, and plasma exchange.