Dear Editor, Vaccination to prevent severe acute respiratory syndrome coronavirus 2 infection offers the most promising approach for containment of the coronavirus disease 2019 (COVID‐19) pandemic. Although the available vaccines are safe and effective, a prothrombotic syndrome in association with thrombocytopaenia (termed vaccine‐induced thrombosis and thrombocytopaenia; VITT) has been observed in a small number of individuals receiving the adenoviral vector‐based vaccines ChAdOx1 (Astra Zeneca, University of Oxford) and Ad26. COV2. S (Janssen; Johnson & Johnson). Whilst attention has largely been focused on cerebral venous sinus thrombosis in this disorder, thrombotic and bleeding complications can also occur at other sites. Here, we report the case of a patient with VITT in whom adrenal haemorrhage was the presenting pathology.

A 38‐year‐old male with no significant medical history and no family history of clotting disorders attended the emergency unit with sudden onset of severe abdominal pain and vomiting. He had received his first dose of the ChAdOx1 vaccine 8 days prior. Observations were normal and his abdomen was nontender. Investigations revealed an elevated white cell count (19.1× 109/L; predominantly neutrophils) and mild thrombocytopenia (139× 109/L). Electrolytes, amylase, renal and liver function were normal, as was fibrinogen concentration and prothrombin/activated partial thromboplastin times. Blood lactate was elevated at 5mmol/L. Plain abdominal X‐ray was unremarkable but computed tomography abdomen showed retroperitoneal fat stranding and