Question: A healthy, 42-year-old woman was admitted with a 3-day history of fever and headache 5 days after the first vaccination with ChAdOx1 nCoV-19 (AstraZeneca). She had not received hormone replacement therapy or oral contraceptives previously. The polymerase chain reaction test for sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. The results of urinalysis and pregnancy test were negative. Brain contrast-enhanced magnetic resonance venography confirmed cerebral sinus–venous thrombosis. Laboratory studies indicated decreased platelet count (30,000/mL3), a high D-dimer level (> 10,000 ng/mL; reference value, 500 ng/mL), and high antiplatelet factor 4 antibody (PF4) level (optical density, 0.634; references value, 0.4). Test results for prothrombin time, activated partial thromboplastin time, antithrombin, and protein C and protein S levels were normal. Screening tests for autoimmune antibodies and thrombotic thrombocytopenic purpura were all negative.

She also complained of upper abdominal pain and bilateral legs edema. Mild impaired liver function tests without jaundice were found. Bedside Doppler ultrasound examination revealed no flow in her right hepatic vein (Figure A). A contrast-enhanced computed tomography scan demonstrated the thrombosis and occlusion in her right hepatic vein