Case Series: Acute Hemorrhagic Encephalomyelitis After SARS-CoV-2 Vaccination

Abstract

We present three cases fulfilling diagnostic criteria of hemorrhagic variants of acute disseminated encephalomyelitis (acute hemorrhagic encephalomyelitis, AHEM) occurring within 9 days after the first shot of ChAdOx1 nCoV-19. AHEM was diagnosed using magnetic resonance imaging, cerebrospinal fluid analysis and brain biopsy in one case. The close temporal association with the vaccination, the immune-related nature of the disease as well as the lack of other canonical precipitating factors suggested that AHEM was a vaccine-related adverse effect. We believe that AHEM might reflect a novel COVID-19 vaccine-related adverse event for which physicians should be vigilant and sensitized.

Acute hemorrhagic leukoencephalitis after administration of the first dose of ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELD™) vaccine

“…One patient succumbed to her illness and one of two surviving patients became vegetative. The third patient showed marginal improvement in sensory manifestations, however, paraparesis persisted even after six weeks of follow-up ( Ancau et al, 2022 ).…”

What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions

“…Garg et al reported many diseases associated with COVID-19 vaccines [57], including acute disseminated encephalomyelitis [58], acute hemorrhagic leukoencephalitis [59], autoimmune encephalitis (AE) [60], Bells' palsy [5,57], cerebral hemorrhage [61], cerebral infarction [6], cerebral venous sinus thrombosis [62], chronic inflammatory demyelinating polyneuropathy (acute-onset) [63], GBS [5,11,64], multiple sclerosis (MS) [65], myasthenia gravis (MG) [66], neuromyelitis optica spectrum disorder (NMOSD) [16], Parsonage-Turner syndrome (Neuralgic amyotrophy) [67], subarachnoid hemorrhage [6,68], thrombophlebitis [69], and transverse myelitis [70] (Table 1). The second most common cause of death after cardiovascular disease is cerebrovascular disease [5].…”

No need for brain biopsy in acute disseminated encephalomyelitis after first Sputnik-V jab

“…We do not agree that post-SARS-CoV-2 vaccination ADEM is a rare complication of SARS-CoV-2 vaccinations ( Lazaro et al, 2022 ). As per the end of March 2022 at least 150 patients with post-SARS-CoV-2 vaccination ADEM or acute, hemorrhagic encephalomyelitis (AHEM) have been either published in medical journals (n = 15) or reported to the Eudra vigilance database of the European Medicine Agency (EMA) (n = 164) ( Ancau et al, 2022 ). Among those reported to the Eudra Vigilance database, 46 had received the AstraZeneca vaccine (AZV), 91 the Biontech Pfizer vaccine, and 27 the Moderna vaccine ( Ancau et al, 2022 ).…”

“…As per the end of March 2022 at least 150 patients with post-SARS-CoV-2 vaccination ADEM or acute, hemorrhagic encephalomyelitis (AHEM) have been either published in medical journals (n = 15) or reported to the Eudra vigilance database of the European Medicine Agency (EMA) (n = 164) ( Ancau et al, 2022 ). Among those reported to the Eudra Vigilance database, 46 had received the AstraZeneca vaccine (AZV), 91 the Biontech Pfizer vaccine, and 27 the Moderna vaccine ( Ancau et al, 2022 ). There are patients with post-SARS-CoV-2 vaccination ADEM who present with intracerebral hemorrhage, also known as AHEM ( Ancau et al, 2022 ).…”

“…Among those reported to the Eudra Vigilance database, 46 had received the AstraZeneca vaccine (AZV), 91 the Biontech Pfizer vaccine, and 27 the Moderna vaccine ( Ancau et al, 2022 ). There are patients with post-SARS-CoV-2 vaccination ADEM who present with intracerebral hemorrhage, also known as AHEM ( Ancau et al, 2022 ). Other patients with post-SARS-CoV-2 vaccination ADEM may present with myelin oligodendrocyte glycoprotein (MOG) antibodies ( Mumoli et al, 2022 ).…”