Multiple Sclerosis Relapses After Vaccination Against SARS-CoV2: 16 cases

 A new-onset case of multiple sclerosis (MS):

Case Report: Multiple Sclerosis Relapses After Vaccination Against SARS-CoV2: A Series of Clinical Cases

Riccardo Nistri1, Elena Barbuti1, Virginia Rinaldi1, Laura Tufano1, Valeria Pozzilli2,3, Antonio Ianniello4, Fabiana Marinelli5, Giovanna De Luca3, Luca Prosperini6, Valentina Tomassini2,3 and Carlo Pozzilli1,4*

READ IT FULL VERSIONE HERE: https://www.frontiersin.org/articles/10.3389/fneur.2021.765954/full

Results: Three out of 16 patients received a diagnosis of MS with a first episode occurring after COVID-19 vaccination; 13 had already a diagnosis of MS and, among them, 9 were on treatment with DMTs. Ten patients received BNT162b2/Pfizer-BioNTech, 2 patients mRNA-1273/Moderna, and 4 patients ChAdOx1 nCoV-19/AstraZeneca. All MS relapses occurred from 3 days to 3 weeks after receiving the first dose of the COVID-19 vaccination or the booster. All patients had evidence of radiological activity on MRI.

Discussion: Clinical and radiological findings in these cohort of MS patients confirmed disease re/activation and suggested a temporal association between disease activity and COVID-19 vaccination. The nature of this temporal association, whether causative or incidental, remains to be established.

Case 1

A 45-year-old man received a diagnosis of MS (7) in 2012 and was started on teriflunomide and then from April 2020 with Ocrelizumab with radiological and clinical stability, as confirmed in November 2020. He received his first ChAdOx1 nCoV-19 on February 19, 2021. He experienced dysesthesia in both legs 3 weeks later. He underwent a scan on April 30, 2021 which showed two new lesions in the temporal gyri and a new spinal cord lesion at T3 level (Figure 1A).

Case 2

A 48-year-old woman received on March 5 her first dose of ChAdOx1 nCoV-19. 8 days later, she developed visual acuity deficit from her right eye. She underwent MRI scan on March 31, where an enhancing lesion in the corpus callosum, multiple white matter unenhanced lesions, and lesions in the occipital lobe were detected (Figure 1B). Diagnosis of MS was made, and she was treated with high dose of intravenous methylprednisolone (IVMP), with marked improvement of the visual deficit.

Case 3

A 54-year-old woman was diagnosed with MS in 1993. She remained clinically stable without any therapy up to 2021. On February 27, 2021, 3 days after the first ChAdOx1 nCoV-19 dose, the patient developed hypoesthesia below the T6 level. She underwent a new MRI showing one enhancing lesion in the spinal cord (Figure 1C). She was treated with IVMP with complete recovery.

Case 4

A 66-year-old woman received the first dose of ChAdOx1 nCoV-19 on April 11, 2021 and, 1 week later, complained visual disturbance and postural instability on the right limbs. A brain MRI on May 4 showed multiple white matter lesions, four of them enhancing in the left paratrigonal and periventricular white matter (Figure 1D). Her CSF showed oligoclonal bands. Diagnosis of MS (7) was made, and she was treated with IVMP with partial improvement.

Case 5

In 2019 a 42-year-old woman experienced a progressive weakness on the right side of her body. After an MRI scan performed in February 2020, showing multiple lesions with dissemination in space and time, she started treatment with Ocrelizumab on May 8, 2020. She received the first dose of mRNA-1273 vaccine on March 22, 2021. Two weeks later, she experienced slight weakness of the left upper limb. On April 19, 2021, she received the booster, and after 3 days, her follow-up MRI showed an enhancing brain lesion in the right corona radiata (Figure 1E).

Case 6

A 57-year-old man had a diagnosis of MS in 2001. He was treated initially with injectables, then with teriflunomide, and, in 2015, with mitoxantrone. Since then, he remained clinically and radiologically stable without any treatment. On May 11, 2021, he received the booster of mRNA-1273 vaccine. Two weeks later, he experienced a severe motor deficit in both legs that made him bed bound. He was admitted to hospital where he underwent an MRI on June 7, 2021, showing an enhancing pontine lesion (Figure 1F). He was treated with IVMP with only partial recovery.

Case 7

A 49-year-old woman was diagnosed with MS in November 2013. She has been on treatment with dimethyl fumarate (DMF) since July 2014, with clinical and radiological stability. On April 1, 2021, she underwent a brain and spinal cord MRI scan, which was stable. On April 8, she received her first BNT162b2 dose of vaccine. Five days after, she developed numbness on the left hand and left side of her head. On April 20, she underwent a new scan, which detected a periventricular lesion and a spinal lesion at C3 level, both enhancing (Figure 1G). She was treated with IVMP with almost complete recovery.

Case 8

In 2014, after the onset of hypoesthesia on his left side, a 39-year-old man underwent an MRI scan, which showed multiple lesions on brain and spinal cord. He started treatment with injectables switched to DMF in 2017. After almost 3 years of clinical and radiological stability, on April 27, 2021, he received his first dose of BNT162b2 vaccine, followed, 10 days later, by the onset of paraesthesia on his left leg. He underwent an MRI scan on May 13 that showed three new lesions, two of which were enhancing in the left parietal lobe and in the periventricular white matter (Figure 1H). He was treated with oral steroids with partial recovery.

Case 9

A 39-year-old woman suffered from her first clinical episode in August 2019 with a complete recovery. A diagnosis of clinically isolated syndrome was made, and she was monitored by serial MRI that confirmed a radiological stability up to January 2021. On April 29, she received her first dose of BNT162b2 vaccine followed, 3 days later, by dysesthesia on her right hand and foot. A scan performed on May 11, 2021 showed a new enhancing lesion in the mesencephalon (Figure 1I). She was treated with IV methylprednisolone with a good recovery. A diagnosis of MS was made, and a DMT was planned.

Case 10

A 60-year-old female patient received a diagnosis of MS in 1998. In 2001, she started treatment with injectables switched to DMF in 2015. She was clinically and radiologically stable for 6 years. In April 2021, she performed the first BNT162b2 dose of vaccine presenting few days later with fatigue and numbness in both legs. A scan was performed, and one enhancing brain lesion was detected in the left periventricular white matter (Figure 1L).

Case 11

A 30-year-old woman was diagnosed with MS in 2018, after a clinical onset with optic neuritis and MRI suggestive of dissemination in space and time. She was treated with DMF between September 2018 and August 2020 and then she started Cladribine. A baseline MRI at the end of October 2020 was stable. She received the BNT162b2 booster on April 8, 2021. Twenty days later, she complained of a language disturbance. A brain MRI performed on June 3, 2021 revealed the presence of two enhancing brain lesions, one in the right corona radiata and one with conspicuous oedema in the left centrum semiovale (Figure 1M).

Case 12

A 58-year-old woman was diagnosed with MS in August 2000. She was treated with injectables and then, in 2018, with DMF that was stopped after 1 year for lymphopenia. She performed an MRI scan in February 2020 that was stable. She had her first BNT162b2 dose on March 26, 2021. Three days later, she complained headache, balance disturbances, urinary incontinence, difficulties in walking, and dysphagia. She performed an MRI on May 27, 2021 that showed a new area with ring enhancement in the white matter of the left frontal lobe (Figure 1N). She started IVMP with benefit.

Case 13

A 34-year-old woman developed numbness and hyposthenia on her right hand in February 2021. An MRI scan showed multiple lesions and one enhancing cord lesion at C3 level. Diagnosis of MS was made. She was treated with IVMP with almost complete recovery. A treatment with Ocrelizumab was planned. On May 18, she received the BNT162b booster. Four days later, she complained of neck pain and hypoesthesia on her right arm. She performed an MRI scan on June 7 showing three brain enhancing lesions (one right posterior paraventricular and two in the left periventricular white matter) and a new unenhanced lesion on spinal cord (Figure 1O).

Case 14

A 35-year-old woman received a diagnosis of MS in the 2005. She was treated with injectables, and in February 2019, she started DMF. She remained clinically and radiologically stable until May 24, 2021, when she received the BNT162b2 booster. The day after the vaccination, she developed paraesthesia on the left side of the body. She underwent a scan 13 days later, which showed three enhancing lesions in the left temporal lobe and left centrum semiovale (Figure 1P).

Case 15

A 54-year-old man was diagnosed with MS in 2003. He was treated with injectables and switched to teriflunomide in November 2020. He was clinically stable and without new lesions on MRI performed on February 25, 2021. On April 7, 2021, 1 week after the first dose of BNT162b2 vaccine (March 31, 2021), he developed a right hemiparesis. A brain scan showed two ring-enhancing lesions located in the left periventricular white matter (Figure 1Q). IVMP was administered with full recovery. He received the BNT162b2/Pfizer-BioNTech booster on May 11, 2021. without any further medical problem.

Case 16

A 37-year-old man was diagnosed with MS in 2019. In April 2020, he started DMF with clinical stability. On June 4, 2021, he had the BNT162b2 booster. On June 15, the patient presented with weakness on his right limbs. On June 24, he underwent a brain MRI that, compared with a previous routine scan of May 20, 2021, showed a new tumefactive contrast-enhancing lesion in the left fronto-parietal white matter (Figure 1R). The patient was treated with IVMP with partial recovery.