Post COVID-19 Vaccination Acute Disseminated Encephalomyelitis: A Case Report

Article ID: e090522204488 Pages: 5

  • * (Excluding Mailing and Handling)

Abstract

Introduction: A 67-year-old female with no significant past medical history presented to the critical care department with symptoms of encephalopathy.

Case Presentation: The patient’s Main Concerns and the Important Clinical Findings: The patient had a history of COVID -19 vaccination (recombinant ChAdOX1 nCoV-19) 14 days prior to the symptoms. She underwent an MRI of the brain and cervical spine and a lumbar puncture.

The Primary Diagnoses, Interventions, and Outcomes: The patient was examined and sent for an MRI of the brain and cervical spine, followed by extensive blood and CSF investigations to rule out any infective, paraneoplastic, connective tissue disorder, or inflammatory disorder. The patient was given steroids, and a good response was reported. The primary diagnosis was made as vaccine-induced ADEM.

Conclusion: The clinical exam, location, sparse contrast enhancement, and CSF findings were all consistent with an acute demyelinating event, and the history of vaccination, together with the clinical situation, was found to be favourable for the development of acute disseminated encephalomyelitis.

Keywords: COVID-19, vaccine, ADEM, encephalopathy, SARS-CoV 2, virus.

[1]
COVID live update: 230,329,713 Cases and 4,722,991 deaths from the coronavirus - worldometer. 2021. Available from:https://www.worldometers.info/coronavirus/?utm_campaign%3DhomeAdvegas1
[2]
Black SB, Law B, Chen RT, et al. The critical role of background rates of possible adverse events in the assessment of COVID-19 vaccine safety. Vaccine 2021; 39(19): 2712-8.
[http://dx.doi.org/10.1016/j.vaccine.2021.03.016] [PMID: 33846042]
[3]
Drugs and Lactation Database (LactMed). Bethesda (MD): National Library of Medicine (US) COVID-19 vaccines 2006.
[4]
Hatziantoniou S, Maltezou HC, Tsakris A, Poland GA, Anastassopoulou C. Anaphylactic reactions to mRNA COVID-19 vaccines: A call for further study. Vaccine 2021; 39(19): 2605-7.
[http://dx.doi.org/10.1016/j.vaccine.2021.03.073] [PMID: 33846043]
[5]
Schultz NH, Sørvoll IH, Michelsen AE, et al. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 vaccination. N Engl J Med 2021; 384(22): 2124-30.
[http://dx.doi.org/10.1056/NEJMoa2104882] [PMID: 33835768]
[6]
Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021; 384(22): 2092-101.
[http://dx.doi.org/10.1056/NEJMoa2104840] [PMID: 33835769]
[7]
Cao L, Ren L. Acute disseminated encephalomyelitis after severe acute respiratory syndrome coronavirus 2 vaccination: A case report. Acta Neurol Belg 2021.
[http://dx.doi.org/10.1007/s13760-021-01608-2] [PMID: 33527327]
[8]
Vogrig A, Janes F, Gigli GL, et al. Acute disseminated encephalomyelitis after SARS-CoV-2 vaccination. Clin Neurol Neurosurg 2021; 208: 106839.
[http://dx.doi.org/10.1016/j.clineuro.2021.106839] [PMID: 34325334]
[9]
Ozgen Kenangil G, Ari BC, Guler C, Demir MK. Acute disseminated encephalomyelitis-like presentation after an inactivated coronavirus vaccine. Acta Neurol Belg 2021; 121(4): 1089-91.
[http://dx.doi.org/10.1007/s13760-021-01699-x] [PMID: 34018145]
[10]
Takata J, Durkin SM, Wong S, Zandi MS, Swanton JK, Corrah TW. A case report of ChAdOx1 nCoV-19 vaccine-associated encephalitis. BMC Neurol 2021; 21(1): 485.
[http://dx.doi.org/10.1186/s12883-021-02517-w] [PMID: 34903200]
[11]
Al-Mashdali AF, Ata YM, Sadik N. Post-COVID-19 vaccine acute hyperactive encephalopathy with dramatic response to methylprednisolone: A case report. Ann Med Surg (Lond) 2021; 69: 102803.
[http://dx.doi.org/10.1016/j.amsu.2021.102803] [PMID: 34512961]
[12]
Fan HT, Lin YY, Chiang WF, et al. COVID-19 vaccine-induced encephalitis and status epilepticus. QJM 2022; 115(2): 91-3.
[http://dx.doi.org/10.1093/qjmed/hcab335] [PMID: 34978572]
[13]
Zlotnik Y, Gadoth A, Abu-Salameh I, Horev A, Novoa R, Ifergane G. Case report: Anti-LGI1 encephalitis following COVID-19 vaccination. Front Immunol 2022; 12: 813487.
[http://dx.doi.org/10.3389/fimmu.2021.813487] [PMID: 35069602]
[14]
Dominguez JL, Eberhardt SC, Revels JW. Unilateral axillary lymphadenopathy following COVID-19 vaccination: A case report and imaging findings. Radiol Case Rep 2021; 16(7): 1660-4.
[http://dx.doi.org/10.1016/j.radcr.2021.04.015] [PMID: 33868525]
[15]
Sejvar JJ, Kohl KS, Bilynsky R, et al. Brighton collaboration encephalitis working group. Encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM): Case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2007; 25(31): 5771-92.
[http://dx.doi.org/10.1016/j.vaccine.2007.04.060] [PMID: 17570566]
[16]
Rath B, Magnus M, Heininger U. Evaluating the brighton collaboration case definitions, aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis, by systematic analysis of 255 clinical cases. Vaccine 2010; 28(19): 3488-95.
[http://dx.doi.org/10.1016/j.vaccine.2010.02.053] [PMID: 20197145]
[17]
Ohya T, Nagamitsu S, Yamashita Y, Matsuishi T. Serial magnetic resonance imaging and single photon emission computed tomography study of acute disseminated encephalomyelitis patient after Japanese encephalitis vaccination. Kurume Med J 2007; 54(3-4): 95-9.
[http://dx.doi.org/10.2739/kurumemedj.54.95] [PMID: 18475044]
[18]
Katal S, Pouraryan A, Gholamrezanezhad A. COVID-19 vaccine is here: Practical considerations for clinical imaging applications. Clin Imaging 2021; 76: 38-41.
[http://dx.doi.org/10.1016/j.clinimag.2021.01.023] [PMID: 33548891]
[19]
Marin SE, Callen DJ. The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis: An update post application of the 2007 consensus criteria. Neuroimaging Clin N Am 2013; 23(2): 245-66.
[http://dx.doi.org/10.1016/j.nic.2012.12.005] [PMID: 23608688]
[20]
Callen DJ, Shroff MM, Branson HM, et al. Role of MRI in the differentiation of ADEM from MS in children. Neurology 2009; 72(11): 968-73.
[http://dx.doi.org/10.1212/01.wnl.0000338630.20412.45] [PMID: 19038851]