We report the case of a 37-year-old male, with no significant past medical history, who, five days after receiving the Janssen Covid-19 vaccine, began experiencing language impairment, disorientation, and psychomotor restlessness. A brain CT scan revealed the presence of left middle cerebral artery ischemia (Fig. 1), as well as a platelet count of 25 000/mm3, which raised suspicion of vaccine-induced thrombotic thrombocytopenia (VITT). This suspicion was later confirmed with positive antibodies against platelet factor 4. Despite treatment with fondaparinux, corticosteroids, and immunoglobulins, the patient's disease progression was poor, with development of abdominal distension with peritonitis and rapid respiratory deterioration that eventually requiring mechanical ventilation. The abdominal CT scan performed at six hours revealed the presence of enterocolic, pancreatic, and gastric ischemia with extensive thrombosis of the portomesenteric axis (Fig. 2 and Fig. 3). Ultimately, the patient passed away

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