Acute disseminated encephalomyelitis. Damage to the brain & spinal cord AFTER ASTRAZENECA

 A 63-year-old man

- 12 days after the 1st dose of the #Covidvaccine (AstraZeneca): vertigo, abdominal pain & fatigue. Later he became poorly responsive & was intubated. ⇒ Acute disseminated encephalomyelitis. Damage to the brain & spinal cord. https://link.springer.com/article/10.1007%2Fs12024-021-00440-7 He died.

Acute disseminated encephalomyelitis (ADEM) following recent Oxford/AstraZeneca COVID-19 vaccination

Abstract

This report describes the clinical context and autopsy findings in the first reported fatal case of acute disseminated encephalomyelitis (ADEM), developed after being vaccinated using the Oxford/AstraZeneca COVID-19 vaccine. ADEM is a rare autoimmune disease, causing demyelination in the brain and spinal cord. A wide variety of precipitating factors can trigger ADEM, and it has long been known to be a rare adverse event following some types of vaccinations. Recently, ADEM has also been associated with COVID-19 infection and (very rarely) with COVID-19 vaccination. The reports of the latter however all pertain to living patients. Our case demonstrates that ADEM should be considered in patients developing neurological symptoms post COVID-19 vaccination, although that this adverse reaction is likely to remain extremely rare. Our report further emphasizes the added value of comprehensive post mortem investigation to confirm ante mortem diagnosis and to determine vaccination safety.

Case presentation

A 63-year-old man, with a medical history including insulin-dependent type II diabetes mellitus, ischemic heart disease and atrial fibrillation, electively received a first dose of the Oxford/AstraZeneca COVID-19 vaccine. Twelve days later he presented to hospital with non-specific symptoms including vertigo, abdominal pain and fatigue. On admission, preliminary tests prompted a working diagnosis of ketoacidosis and silent myocardial infarction. In the first days after admission he deteriorated neurologically, with declining cognition, emerging disorientation and impaired attention. On day four, he suddenly became poorly responsive. Clinical tests led to a presumed diagnosis of encephalitis, and empiric antibiotics and antivirals were started. He was intubated the following day.