Management of Refractory Gingival Bleeding During Periodontal Therapy in Vaccine‐Associated Immune Thrombocytopenia: A Case Report
Hee‐Jin Kim, Kyung‐San MinABSTRACT
Background
Secondary immune thrombocytopenia (SITP) has been rarely reported following mRNA COVID‐19 vaccination. Oral manifestations such as gingival bleeding remain underrecognized in dental practice.
Case presentation
A 58‐year‐old woman developed extensive ecchymoses, blood‐tinged sputum, and spontaneous gingival bleeding approximately 2 weeks after receiving the second dose of the mRNA‐1273 COVID‐19 vaccine. Laboratory testing revealed severe isolated thrombocytopenia, while coagulation parameters, D‐dimer, and fibrinogen levels were within normal limits. After exclusion of other identifiable causes, she was diagnosed with suspected SITP temporally associated with COVID‐19 vaccination. Initial treatment with dexamethasone resulted in an insufficient platelet response; therefore, intravenous immunoglobulin was administered, leading to platelet recovery. During the subsequent periodontal scaling, however, profuse gingival bleeding occurred despite a platelet count exceeding 50 × 10 3 /µL. Conventional local hemostatic measures, including pressure application and retraction paste, were unsuccessful. Fibrin glue was then applied, resulting in immediate hemostasis without recurrent bleeding during follow‐up.
Conclusion
This case highlights the importance of recognizing vaccine‐associated SITP in dentistry and demonstrates fibrin glue as an effective adjunctive hemostatic measure when conventional approaches are insufficient.