Fatal thrombotic microangiopathy with rhabdomyolysis as an initial symptom after the first dose of mRNA–1273 vaccine: A case report.

• The patient developed leg pain and livedo reticularis after mRNA-1273 vaccination. • His blood creatine kinase level was markedly elevated and MRI showed myositis. • He developed rhabdomyolysis and died of multiorgan failure. • Histopathology of autopsy specimens revealed systemic arteriole thrombosis. • Vaccine-induced complement activation syndrome may have caused the lesions. We report a case of a Japanese man with severe rhabdomyolysis and multiple thrombosis of arterioles after the first dose of mRNA-1273 vaccine. He developed rapidly progressive rhabdomyolysis and infarctions of multiple organs. Antiplatelet factor 4 antibody test was negative. Despite the intensive supportive care, including aggressive fluid administration, hemodialysis, administration of anticoagulants, high-dose steroid, and eculizumab, the patient ultimately died of multiple organ failure. Autopsy revealed multiple thrombosis in the arterioles and organ necrosis. Low serum complements and C3 deposition in the renal glomeruli detected by immunofluorescence suggested a possible immune-mediated mechanism. To our knowledge, this is the first case report of rhabdomyolysis and multiple thrombosis of the arterioles as an adverse event following COVID-19 vaccination. [ABSTRACT FROM AUTHOR]