Miller Fisher syndrome following BNT162b2 mRNA coronavirus 2019 vaccination

Nishiguchi, Yamato; Matsuyama, Hirofumi; Maeda, Kuniko; Shindo, Akihiro; Tomimoto, Hidekazu

doi:10.1186/s12883-021-02489-x

Cited by 33 publications

(23 citation statements)

References 17 publications

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“…Nishiguchi et al [19] 71 years/male Pfizer/BioNTech Headache, oculomotor nerve palsy, ocular pain, ptosis, and limb ataxia. Michaelson et al [17] 78 years/male Pfizer/BioNTech Mixed diplopia, paresthesia of the hands and feet, and severe gait ataxia.…”

Section: Author Contributionsmentioning

confidence: 99%

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

et al. 2022

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Rationale: Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations. Patient concerns: A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac–Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers. Diagnoses: Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies. Interventions: A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions. Outcomes: Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge. Lessons: This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.

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Section: Author Contributionsmentioning

confidence: 99%

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

et al. 2022

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“…Among 460 cases vaccinated for COVID (involving viral vector-based vaccines, mRNA vaccine, and inactivated virus vaccine), the following adverse events reported: ➣ Two hundred thirty-seven cases of thrombosis, ranged from cerebral venous thrombosis, thrombosis thrombocytopenic purpura, and pulmonary embolism [ 4 – 11 ] ➣ Two cases of acute myocardial infarction (AMI) [ 12 ] ➣ Twenty-two cases of myocarditis [ 13 – 15 ] ➣ Four cases of idiopathic thrombocytopenia (ITP) [ 16 – 19 ] ➣ Thirty-three cases of intracranial hemorrhage (ICH) [ 5 ] ➣ Five cases of disseminated intravascular coagulopathy (DIC) [ 10 ] ➣ Twenty cases of Guillian-Barre syndrome (GBS) [ 20 – 23 ] ➣ Nine case of acute transverse myelitis (ATM) [ 24 ] ➣ Two cases of acute demyelinating polyradiculopathy (ADPR) [ 25 ] ➣ One case of Miller Fisher syndrome (MFS) [ 26 ] ➣ Two cases of acute disseminated encephalomyelitis (ADEM) [ 27 , 28 ] ➣ Three inflammatory myositis [ 2 ] ➣ Forty-one cases of renal adverse events (Ig A nephropathy, anti-GBM nephropathy, ANCA, and paucimmune glomerulopathy) [ 29 , 30 ]. ➣ One case of erythema nodosum (EN) [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…➣ Twenty cases of Guillian-Barre syndrome (GBS) [ 20 – 23 ] ➣ Nine case of acute transverse myelitis (ATM) [ 24 ] ➣ Two cases of acute demyelinating polyradiculopathy (ADPR) [ 25 ] ➣ One case of Miller Fisher syndrome (MFS) [ 26 ] ➣ Two cases of acute disseminated encephalomyelitis (ADEM) [ 27 , 28 ] ➣ Three inflammatory myositis [ 2 ] ➣ Forty-one cases of renal adverse events (Ig A nephropathy, anti-GBM nephropathy, ANCA, and paucimmune glomerulopathy) [ 29 , 30 ]. ➣ One case of erythema nodosum (EN) [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Immune-mediated adverse events post-COVID vaccination and types of vaccines: a systematic review and meta-analysis

ElSawi

Elborollosy

2022

Egypt J Intern Med

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Background In late 2019, Coronavirus disease 2019 has been declared as a global emergency by World Health Organization. Hopefully, recent reports of effective and safe vaccines were welcomed, and approved on emergency base. Millions of recipients had received one of the approved COVID 19 vaccines, with lots of adverse events recorded global wide. Objective To assess post-COVID vaccination immune-mediated adverse events and evaluate its association to specific type of vaccine global wide. Methods Systematic literature review and meta-analysis of published reports (since December 2020 till December 2021) on immune-mediated adverse events post-COVID vaccination. Results We evaluated 34 published studies; 460 cases with various adverse events post-COVID vaccination. Studies in current literature are primarily retrospective case series, isolated case reports or narrative studies. Different COVID vaccines were involved. Results’ data was subcategorized according to associated vaccine. Adverse effects of COVID-19 vaccinations included thrombotic, neurological, myocarditis, ocular, dermatological, renal, hematological events timely linked to inoculation. Each vaccine type was linked to adverse profile that differ from others. Conclusion High suspicion of post-vaccination adverse events is mandatory to provoke earlier detection, better understanding, optimum prevention, and management. Specific vaccine/patient risk profile is needed to selectively categorize target population to reduce morbidity and mortality post-vaccination.

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“…Given the overlapping presentation with MFS, the patient was treated with IVIG with complete response. CSF and neurophysiological studies, and anti Gq1b testing were all negative 257 …”

Section: Methodsmentioning

confidence: 99%

“…256 An additional report of acute bilateral oculomotor nerve palsy, likely overlapping with an incomplete variant of MFS (ie, acute ophtalmoparesis), has been reported 18 days after the first dose of Pfizer vaccine. 257 Given the overlapping presentation with MFS, the patient was treated with IVIG with complete response. CSF and neurophysiological studies, and anti Gq1b testing were all negative.…”

Section: Covid-19 Vaccines and Cranial Neuropathiesmentioning

confidence: 99%

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

Taga

Lauria

2022

J Peripheral Nervous Sys

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Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.

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Miller Fisher syndrome following BNT162b2 mRNA coronavirus 2019 vaccination

Cited by 33 publications

References 17 publications

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature

Immune-mediated adverse events post-COVID vaccination and types of vaccines: a systematic review and meta-analysis

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

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