Incomplete Subacute Transverse Myelitis Following Vaccination With Pfizer-BioNTech COVID-19 mRNA Vaccine: A Case Report

Abstract

In response to the coronavirus disease 2019 (COVID-19) pandemic, rapid development, clinical testing, and regulatory approval of vaccines occurred. The tozinameran COVID-19 vaccine is the first mRNA vaccine approved for use in humans. Transverse myelitis is a rare inflammatory disorder of the spinal cord that is associated with traditional vaccinations. There are rare case reports describing an association between mRNA vaccines and transverse myelitis. Herein, we describe a case of transverse myelitis following mRNA vaccination. A healthy 26-year-old woman developed saddle anesthesia, numbness, and allodynia in the S1-S4 distribution within three days of receiving the first dose of tozinameran COVID-19 vaccine. She had decreased sensation to pinprick, temperature, and light touch in S1-S4 distribution and a positive Rhomberg test. An MRI brain and spine demonstrated a short segment T2 hyperintense and diffusely enhancing lesion at T5. Cerebrospinal fluid studies demonstrated pleocytosis and elevated IgG index. A five-day course of IV methylprednisolone resulted in minimal improvements in her symptoms. Stage III clinical trials may be underpowered to detect more rare adverse effects such as transverse myelitis. Therefore, it is imperative to have ongoing surveillance and reporting of adverse events associated with COVID-19 vaccines to ensure transparency with regard to potential risks to patients obtaining the vaccine and algorithms in place for detection and urgent treatment if required. Nonetheless, the safety and efficacy of vaccination against COVID-19 are well established and greatly outweigh any potential risks associated with the vaccine. Given the individual, societal, and global health benefits of vaccination we strongly advocate for ongoing vaccinations against COVID-19.

CNS inflammatory demyelinating events after COVID-19 vaccines: A case series and systematic review

“…Out of 11 ADEM ( 41 – 49 ), six occurred after an adenoviral-vectored (55%), three after an mRNA-based (27%), and two after an inactivated vaccine (18%; Figure 4A ). The median time from vaccine to symptoms onset was 12.5 days ( 2 – 30 ) ( Figure 4D ), with all but one case occurring at least after 7 days. Median age was 46 years and the female sex was prevalent (73%; Figures 4B , C ).…”

Clinical characteristics, radiological features and prognostic factors of transverse myelitis following COVID-19 vaccination: A systematic review

“…The PRISMA flowchart ( Figure 1 ) showed a search strategy for our review. The present study consisted of 28 studies, including 26 case reports, one case series, and one cross-sectional, and the pooled data of 31 patients with COVID-19 vaccine-associated ATM is extracted ( Sriwastava et al, 2021 , Sepahvand et al, 2022 , Tan et al, 2021 , Corrêa et al, 2021 , Vegezzi et al, 2021 , Hsiao et al, 2021 , Pagenkopf and Südmeyer, 2021 , Notghi et al, 2021 , Gao et al, 2021 , Malhotra et al, 2021 , Khan et al, 2022 , Erdem et al, 2021 , Hirose et al, 2021 , Tahir et al, 2021 , Miyaue et al, 2021 , Fujikawa et al, 2021 , Kaulen et al, 2022 , McLean and Trefts, 2021 , Alabkal et al, 2021 , Fitzsimmons and Nance, 2021 , Nakano et al, 2022 , Spataro et al, 2022 , Cabral et al, 2022 , Khan et al, 2022 , Maroufi et al, 2022 , Eom et al, 2022 , Netravathi et al, 2022 , Esechie et al, 2022 ). All of the selected studies were written in the English language.…”

Spontaneous reporting of adverse reactions associated with the COVID-19 vaccine in health care professionals: A descriptive observational study conducted in a Portuguese hospital

“…However, it was not possible to conclude on the causal link between the two events since the subject in question was under long-term treatment with a TNF-a inhibitor for rheumatoid arthritis, which has been associated with an increased risk of demyelinating diseases 29 . Despite this, rare cases of transverse myelitis after the Pfizer-BioNTech COVID-19 vaccine have been described in the literature [30][31][32][33] . A case of sudden hearing loss was also observed; however, studies have shown that there is no clear association between this adverse reaction and the administration of vaccines against COVID-19 34 .…”