Multiple sclerosis (MS) a few days after receiving the 1st dose of the CovidVaccine (Pfizer-BioNTech).
A case of a 32-year-old woman who presented with symptoms and suggestive of multiple sclerosis (MS) a few days after receiving the 1st dose of the #CovidVaccine (Pfizer-BioNTech).
Laboratory and imaging findings confirmed the diagnosis of MS. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8604537/A rare presentation of undiagnosed multiple sclerosis after the COVID-19 vaccine
ABSTRACT
Multiple sclerosis (MS) is an auto-immune mediated neurological disorder that affects the central nervous system and leads to myelin sheath destruction. The pathogenesis of MS involves T helper cells causing inflammation and eventual death of the oligodendrocytes. Etiologies for the development of MS include a combination of genetic, environmental, and immune factors. Vaccines have been proposed to increase the immune response and have reportedly activated some autoimmune disorders. Although certain vaccines such as hepatitis B have been associated with MS, studies have refuted these cases. We present a rare case of a 32-year-old patient who presented with symptoms and suggestive of MS a few days after receiving the COVID vaccine. Laboratory and imaging findings confirmed the diagnosis of MS, and she was started on steroids and discharged in a stable condition a few days after.
2. Case
A 32-year-old female with no past medical history presented to the emergency department with right-sided weakness which started one week after receiving the first dose of the BNT162b2 Coronavirus disease-19 (COVID-19) vaccine. Immediately following the first dose, the patient experienced left arm soreness at the site of injection, subjective fevers, and chills. Three days later, she developed fine motor weakness in the right hand, word slurring, and gait instability which eventually progressed into diffuse right-sided weakness in her upper and lower extremities. The patient denied a history of similar symptoms and has no personal or family history of autoimmune or neurological disease. On arrival, her vital signs were unremarkable. On physical examination, the cranial nerves were grossly intact; however, strength was 3/5 and sensation was diminished in the right upper and lower extremities compared to the left. Laboratory findings were remarkable for an elevated white blood cell count of 11.3 (4.5–11×103/mm3) and ESR at 24 (0–20); however, CRP was within normal limits. Vitamin D level was low at 12.2 (30–100 ng/mL). Computerized Tomography of the head without contrast did not show any abnormalities. Magnetic Resonance (MR) Imaging showed multiple round hyperintensities in the white matter with restricted diffusion in the left pons, concerning for possible demyelinating disease (Figures 1 and Figures 2). MR angiography and MR venography of the brain showed normal vasculature (Figure 3). Further workup included a lumbar puncture and the cerebrospinal fluid results were significant for elevated myelin basic protein 13.3 (0–3.7) and greater than six oligoclonal bands (0–3) were seen on cytology, diagnostic for multiple sclerosis. The patient was started on intravenous Methylprednisolone 1 g for 3 days and was subsequently discharged on Prednisone 60 mg for 11 days.
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4. Conclusion
Vaccines are proposed to cause an increased immune response, which in turn triggers the self-antigens of the immune system; however, there is no definitive causative association between the two. This paper reports a rare case of MS triggered a few days after receiving the COVID-19 vaccine. The time between vaccination and onset of symptoms favors this association, supported by the lab and imaging findings which confirmed the diagnosis. However, more data is needed regarding the association between COVID-19 vaccines and activation of MS or other autoimmune diseases.
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