New diagnosis of multiple sclerosis in the setting of mRNA COVID-19 vaccine exposure

Abstract

Background Multiple sclerosis (MS) with onset in the setting of acute SARS-CoV-2 virus infection has been reported, and reactivation of MS following non-mRNA COVID-19 vaccination has been noted, but there have only been three reports of newly diagnosed MS following exposure to mRNA COVID-19 vaccine. The association cannot be determined to be causal, as latent central nervous system demyelinating disease may unmask itself in the setting of an infection or a systemic inflammatory response. We report a series of 5 cases of newly diagnosed MS following recent exposure to mRNA COVID-19 vaccines. Latency from vaccination to initial presentation varied. Neurological manifestations and clinical course appeared to be typical for MS including response to high dose steroids in 4 cases and additional need for plasmapheresis in one case. Conclusion Acute neurological deficits in the setting of recent mRNA COVID-19 vaccine administration may represent new onset multiple sclerosis.

Acute Multiple Sclerosis Exacerbation After Vaccination With the Johnson & Johnson COVID-19 Vaccine: Novel Presentation and First Documented Case Report

“…Many of these factors are modifiable and could potentially aid in MSR prevention and management. The role of viruses in the pathogenesis of MS is presumably related to the activation of self-reactive T-cells that target the CNS; however, the exact mechanism remains unknown [ 8 ].…”

“…Aside from the yellow fever vaccine, studies thus far have failed to demonstrate a clear relationship between vaccination and MS development or MSR [ 8 ]. It has been postulated that the inflammatory response generated by vaccinations in the background of an already altered immune system, such as in those with autoimmune conditions or those susceptible to developing them, may play a role in unmasking the disease after vaccination [ 8 ].…”

“…Aside from the yellow fever vaccine, studies thus far have failed to demonstrate a clear relationship between vaccination and MS development or MSR [ 8 ]. It has been postulated that the inflammatory response generated by vaccinations in the background of an already altered immune system, such as in those with autoimmune conditions or those susceptible to developing them, may play a role in unmasking the disease after vaccination [ 8 ]. Studies have suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger autoimmune diseases, such as immune-mediated thrombotic thrombocytopenia, CNS demyelinating diseases, inflammatory peripheral neuropathies, myositis, myasthenia gravis, limbic encephalitis, and giant cell arteritis [ 9 ].…”

“…Ten patients received the Pfizer-BioNTech vaccine (Pfizer Inc., New York, US; BioNTech SE, Mainz, Germany), two received the Moderna vaccine (Moderna, Inc., Cambridge, Massachusetts, US), and four received the AstraZeneca vaccine (AstraZeneca plc, Cambridge, United Kingdom). Additionally, there have been five reports of newly diagnosed MS following mRNA COVID-19 vaccination; however, the MRI studies demonstrated a mix of old and new lesions, meaning that there may have been clinically latent disease present prior to vaccination [ 8 ]. Three of these cases involved vaccination with the Pfizer-BioNTech vaccine and two with the Moderna vaccine.…”

Rheumatologists’ knowledge and perception of COVID-19 and related vaccines: the vaXurvey2 online survey

“…Of the participant physicians had MS before vaccination without any AEs post-vaccination. Acute neurological deficits in the setting of recent mRNA COVID-19 vaccine administration may represent new-onset multiple sclerosis [ 25 ]. Headache was shown in 31% as presented in a prior study [ 26 ].…”