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

This correspondence describes two patients, a 5-year-old boy and a 58-year-old woman who developed symptomatic adenovirus infection, followed days later by severe thrombocytopenia, coagulopathy, and thrombotic events. Neither had previous heparin exposure. Serologic testing revealed VITT-like antibodies to platelet factor 4 (PF4), including strong reactivity in ELISA and serotonin release assays and epitope binding patterns resembling those seen in vaccine-induced immune thrombotic thrombocytopenia (VITT). This study provides evidence that natural adenovirus infection, independent of vaccination, can trigger a VITT-like prothrombotic disorder and suggests PF4-antibody testing be considered for patients with unexplained thrombosis and thrombocytopenia.

This correspondence describes two patients, a 5-year-old boy and a 58-year-old woman who developed symptomatic adenovirus infection, followed days later by severe thrombocytopenia, coagulopathy, and thrombotic events. Neither had previous heparin exposure. Serologic testing revealed VITT-like antibodies to platelet factor 4 (PF4), including strong reactivity in ELISA and serotonin release assays and epitope binding patterns resembling those seen in vaccine-induced immune thrombotic thrombocytopenia (VITT). This study provides evidence that natural adenovirus infection, independent of vaccination, can trigger a VITT-like prothrombotic disorder and suggests PF4-antibody testing be considered for patients with unexplained thrombosis and thrombocytopenia.