Acute Transverse Myelitis and Acute Motor Axonal Neuropathy Developed after Vaccinations against Seasonal and 2009 A/H1N1 Influenza

Abstract

Acute transverse myelitis (ATM) has been described as an uncommon complication of vaccinations and is rarely accompanied by inflammatory peripheral neuropathy. We report a case of a 77-year-old woman who developed ATM and acute motor axonal neuropathy (AMAN) following vaccinations against seasonal and 2009 A/H1N1 influenza. She manifested ophthalmoplegia, quadriparesis and sensory impairment. MR imaging showed a longitudinally-extensive spinal cord lesion, and nerve conduction study revealed motor axonal polyneuropathy. Despite prompt treatment, her symptoms poorly recovered. While concurrent ATM and AMAN may suggest the presence of a common antigen, their scarcity indicates the importance of other factors causing immunologic disruptions.

Analysis of age of onset, pre-existing infections, and features of magnetic resonance imaging results in patients with acute myelitis

“…Currently, the disease is also presumed to be caused by effects of the immune response following virus infections rather than by direct viral infections in the spinal cord. In some cases, AM was diagnosed after vaccinations that could lead to abnormal immunological responses (Sato et al, 2011). In this study, 35% of patients had symptoms of pre-existing infections, which is lower than the 40% reported in previous studies.…”

Use of population based background rates of disease to assess vaccine safety in childhood and mass immunisation in Denmark: nationwide population based cohort study

“…The fast implementation of the vaccines used against the H1N1 influenza pandemic was unprecedented on a global scale and evoked anticipated concerns of unknown adverse effects. Numerous studies have since raised or dealt with the apprehension that this vaccine could be associated with Guillain-Barré syndrome,31 32 33 34 transverse myelitis,35 36 narcolepsy in children,37 38 39 retrograde amnesia,40 or other adverse events 233 41 42 However, such analyses usually cannot be produced in time to respond to the rapidly evolving safety concern when reports of vaccine related adverse events spread quickly throughout society by the internet and mass media, leading to the loss of public confidence.…”

Simultaneous Development of Acute Disseminated Encephalomyelitis and Guillain-Barré Syndrome Associated with H1N1 09 Influenza Vaccination

“…Anti-GM1 antibodies were positive in that patient, and the partial effectiveness of steroid therapy was described. Sato et al reported a case of acute transverse myelitis and AMAN after H1N1 influenza vaccination, with negative anti-ganglioside antibodies (11). They performed highdose immunoglobulin and steroid treatment, however, the patient did not experience a significant recovery.…”