multiple sclerosis after immunization with the Pfizer-BioNTech COVID-19 vaccine

Clinical manifestation of multiple sclerosis after immunization with the Pfizer-BioNTech COVID-19 vaccine

Highlights

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  A 40-year-old woman developed myelitis after immunization with the COVID-19 vaccine.
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  Myelitis was considered the initial clinical manifestation of multiple sclerosis (MS).
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  Subsequent treatment with high-dose IV methylprednisolone led to recovery.
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• 2. Case description

  A 40-year-old woman was referred to the Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital after she developed numbness and sensory disturbance in her right hand that gradually ascended to her right shoulder over a week. She had received the second dose of the BNT162b2 vaccine two weeks before the onset. After vaccination, she suffered from transient high-grade fever (38.5 degrees) without other symptoms. Her past history revealed that she was treated with steroids for left peripheral facial nerve palsy with full recovery 4 years ago. On admission, neurological examination revealed sensory disturbance in the dermatome of the right cervical 5th to 8th area. A brain MRI showed several periventricular or subcortical T2 hyperintense white matter lesions but no brainstem lesions (Fig. 1). These white matter lesions did not show abnormal gadolinium enhancement. A cervical spine MRI revealed a T2 hyperintense right spinal cord lesion with gadolinium enhancement at the level of C5/C6 (Fig. 2A, B ). Cerebrospinal fluid (CSF) analysis showed slightly elevated leukocytes (4 cells/ml; 100% mononuclear cells), normal protein levels (27 mg/dl) and normal glucose levels (60 mg/dl). The oligoclonal IgG band, which was examined using an automatic electrophoresis processor based on a high-sensitive isoelectric focusing technique on agarose gel followed by immunofixation with peroxidase labelled anti-IgG, was positive. The IgG index was 1.04. The myelin basic protein (MBP) in the CSF was 146 pg/ml (below 102). The CSF interleukin-6 level was 2.4 pg/ml (below 4.0). Examinations for infectious CNS diseases, including herpes infection, vasculitis, collagen diseases, and sarcoidosis, were unremarkable. Serum aquaporin 4 (AQP4)-IgG and myelin oligodendrocyte glycoprotein (MOG)-IgG were assayed and turned out to be negative by live-cell-based assay (CBA) using full-length human AQP4 or MOG-transfected HEK 293 cells with IgG gamma-specific secondary antibodies as performed in our previous reports (

  Sato et al., 2014

  ) (

  Takahashi et al., 2007

  ). SARS-CoV-2 infection was excluded on the basis of a negative PCR test and clinical symptoms. After relevant differential diagnoses were excluded, we diagnosed her with MS based on the 2017 McDonald criteria (

  Thompson et al., 2018

  ). Subsequent treatment with high-dose IV methylprednisolone (HIMP) (1000 mg methylprednisolone i.v. for three days) led to recovery (Fig. 2C).

  

  Fig. 1Axial fluid-attenuated inversion recovery (FLAIR) imaging (A, B) (TR, 9000 ms; TE, 111 ms) MRI scan of the head on admission revealed left periventricular and bilateral frontal subcortical high-intensity lesions.

https://www.jni-journal.com/article/S0165-5728(21)00282-4/fulltext