Neuromyelitis Optica in a Healthy Female After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccine

Fujikawa, Priscilla; Shah, Farhan A; Braford, Michalla; Patel, Kashyap; Madey, Jason

doi:10.7759/cureus.17961

Cited by 33 publications

(46 citation statements)

References 11 publications

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“…With regards to NMOSD, there is very limited data linking COVID-19 vaccinations with disease onset. A case report from Fujikawa and colleagues describe a 46-year-old woman presenting with LETM involving C6-T2 without enhancement diagnosed 10 days following the SARS-CoV-2 mRNA-1273 (Moderna) vaccine [9]. In contrast to our case, serum AQP4 antibodies were negative.…”

Section: Discussion Conclusioncontrasting

confidence: 66%

Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: A Case Report.

Kuntz

Saab

Schneider

2022

Preprint

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Background: We report a case of de novo aquaporin-4 positive neuromyelitis optica spectrum disorder following BNT162b SARS-CoV-2 vaccination.Case Presentation: An 80-year-old South Asian man presented two days following his second dose of the Pfizer-BioNTech COVID-19 mRNA BNT162b2 vaccine with progressive left-sided leg weakness and numbness resulting in falls. MRI of the spine revealed a longitudinally extensive transverse myelitis from T3-T4 to T9-T10. Serum antibody testing revealed positive aquaporin-4 (AQP4) antibodies. He was diagnosed with de novo AQP4 positive neuromyelitis optica spectrum disorder (NMOSD) and was treated with high dose intravenous methylprednisolone and plasma exchange with some improvement. He was subsequently treated with mycophenolate mofetil and a slow steroid wean.Conclusions: Evidence suggests vaccinations may trigger de novo NMOSD or NMOSD relapses in some individuals. Ongoing vaccine surveillance and research are needed to understand the risk of NMOSD post-COVID-19 vaccinations further.

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Section: Discussion Conclusioncontrasting

confidence: 66%

Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: A Case Report.

Kuntz

Saab

Schneider

2022

Preprint

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“…Postvaccination relapses with tetanus/diphtheria toxin and influenza vaccine may rarely occur in NMOSD patients 19. Of note, an index demyelinating attack rather than a relapse of NMOSD has been reported with seasonal influenza,20 Japanese encephalitis virus,21 inactivated SARS-CoV2,22 ChAdOx1 nCoV-19,23 and SARS-CoV2 mRNA-1273,24 and Sputnik V COVID-19 vaccine 25…”

Section: Discussionmentioning

confidence: 99%

A Case With New-Onset Neuromyelitis Optica Spectrum Disorder Following COVID-19 mRNA BNT162b2 Vaccination

et al. 2022

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Introduction: In the midst of the coronavirus disease of 2019 pandemic, active immunization by effective vaccination gained utmost importance in terms of global health. The messenger RNA (mRNA) vaccines are novel strategies requiring clinical surveillance for adverse events. Case Report: We report a 43-year-old previously healthy female with an optic neuritis attack 24 hours following immunization with the second dose of coronavirus disease of 2019 mRNA BNT162b2 vaccine. A second transverse myelitis attack together with an elevated anti-AQP-4 antibody titer confirmed the diagnosis of neuromyelitis optica spectrum disorder. Conclusion: Our case identifies the BNT162b2 vaccine as a possible trigger for neuromyelitis optica spectrum disorder. This rare and potentially coincidental event has no implications for vaccine administration practices. However, further research is needed to elucidate the effects of mRNA vaccines on humoral and cell-mediated immunity.

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“…The present case was noteworthy in terms of its association with the vaccine, the type of vaccine, and AQP4-IgG status. Previously, there have been some reports of cases of NMOSD after COVID-19 vaccination, such as AQP4-IgG-positive NMOSD development two months after administration of inactivated vaccine [1], AQP4-IgG-positive after Gam-COVID-Vac [2], and AQP4-IgG-negative after mRNA-1273 [3]. In the present case, the duration from vaccination to development was two weeks.…”

Section: Discussionmentioning

confidence: 53%

First Manifestation of AQP4-IgG-Positive Neuromyelitis Optica Spectrum Disorder Associated with the COVID-19 mRNA Vaccine BNT162b2

Umezawa

Ioka

Aizawa

et al. 2022

Preprint

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BNT162b2 is one of the effective COVID-19 vaccines. However, some researchers have also reported that the vaccines caused some neurological complications. Here, we present a case of a 52-year-old female who developed aquaporin (AQP) 4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) fourteen days after the first dose of BNT162b2. She experienced pain of the neck, weakness of the left arm and leg, numbness of the left hand, and impaired temperature sensation of the right leg. MRI showed T2WI hyperintense lesions in the area postrema and cervical spinal cord ranging from C1 to C6 level, and Gd-enhanced lesions from C3 to C5 level; especially left lateral column was predominantly enhanced. Cell-based assays showed anti-AQP4 antibody (AQP4Ab) was positive. We diagnosed AQP4-IgG-positive NMOSD. After high-dose glucocorticoid therapy, she is showing improved symptoms. The present case was characterized by the findings that a Gd-enhanced lesion in the cervical cord localized dominantly at the left lateral column, consistent with the side of the shoulder where the vaccine was injected. Many studies suggested that AQP4-IgG-positive NMOSD development has multistep mechanisms following the blood-brain barrier (BBB) breakdown. We suspected that BNT162b2-associated immune responses lead to BBB disruptions. Through the limitedly damaged BBB, the plasma cells producing AQP4Abs might be recruited to CNS, and AQP4Abs might bind to the cervical cord and the area postrema. A large population-based study revealed that BNT162b2-associated complications were less likely to be observed than COVID-19 infectious symptoms. However, considering the present case, neurologists need to observe the conditions following vaccination.

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Neuromyelitis Optica in a Healthy Female After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccine

Cited by 33 publications

References 11 publications

Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: A Case Report.

Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: A Case Report.

A Case With New-Onset Neuromyelitis Optica Spectrum Disorder Following COVID-19 mRNA BNT162b2 Vaccination

First Manifestation of AQP4-IgG-Positive Neuromyelitis Optica Spectrum Disorder Associated with the COVID-19 mRNA Vaccine BNT162b2

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