Parsonage-Turner Syndrome After COVID-19 Vaccination in a Child

Abstract

Parsonage-Turner syndrome (PTS) is a peripheral neuropathy involving the brachial plexus very rare in childhood. To date, no cases of PTS after COVID-19 vaccination have been reported in children. We report a case of a 15-year-old boy affected by PTS after the second dose of the BNT162b2 (Comirnaty, Pfizer-BioNTech) COVID-19 vaccine. Parsonage-Turner syndrome (PTS) is a rare peripheral neuropathy involving the brachial plexus characterized by sudden onset pain affecting the upper extremity associated with muscle weakness. With an estimated incidence of 1.64 cases per 100,000 people, 1 PTS usually develops in people aged between 20 and 60 years, being very rare in children.The diagnosis is based on clinical history, physical examination, electrophysiological study, and exclusion of other pathologies. The clinical picture of PTS is very diverse because a large variety of nerves can be affected. Muscle paresis commonly manifests as scapula alata, secondary to paresis of the muscles involved in scapular fixation. 2 Pain is the first symptom in 90% of patients, being the location of pain variable, but in most cases radiated from the cervical spine or shoulder region into the arm. 1 Electrodiagnostic testing is widely used to diagnose PTS. Abnormal sensory potentials, lack of denervation potentials, and abnormal conduction velocities are the most frequent findings.The etiology and pathophysiology of PTS still remain unclear. 3 Recent viral infections, such as herpes simplex virus, Epstein-Barr virus, cytomegalovirus, HIV, hepatitis B virus, and parvovirus B19 infections, have been reported as the probable trigger in 25% of patients with PTS. [4][5][6] Vaccination has been described to precede PTS in 4.3% to 15.5% of cases. 1,5 To date, only a few cases of PTS after COVID-19 vaccination have been reported, none of them in the childhood. [7][8][9][10][11][12][13][14][15] In this study, we report a case of a child affected by PTS after the second dose of COVID-19 vaccination. CaseA 15-year-old boy presented to the clinic because of acute pain and functional impotence in his left shoulder that started 1 week before. Physical examination revealed reduced range of motion for shoulder flexion and abduction because of weakness and pain. He had full flexion and extension of the wrist and fingers as well as hand interosseous muscles. Four weeks earlier, he had received the

Parsonage–Turner Syndrome following COVID-19 Vaccination: A Systematic Review

“…This systematic review included 30 articles [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] and 10 meeting abstracts [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] reporting on 59 cases. Among them, 36 (61.0%) patients received a mRNA vaccine (24 with BNT162b2, Pfizer, 10 with mRNA-1273, Moderna) [ 22 , 24 , 25 , 26 , 27 , 29 , 30 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , …”

“…In both groups, the patients were prescribed various regimens, including corticosteroids [ 22 , 24 , 25 , 26 , 28 , 29 , 30 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 48 , 50 , 53 , 56 , 60 ], nonsteroidal anti-inflammatory drugs (NSAIDs) [ 25 , 33 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 49 ], Pregabalin [ 26 , 39 , 44 , 48 ], Gabapentin [ 24 , 41 , 50 ], and acetaminophen [ 44 , 53 ]. In addition, in the mRNA group, one patient (2.9%) received intravenous immunoglobulin [ 46 ], two were prescribed tricyclic antidepressants (5.7%) [ 39 , 48 ], and four (11.4%) received opiates [ 39 , 48 , 53 , 60 ].…”

“…The outcome of PTS was unclear in three (8.3%) individuals in the mRNA group and six (33.3%) in the viral vector vaccines group. In patients receiving mRNA vaccines, one had a complete remission of symptoms by week 3 [ 39 ], two cases had a full recovery after 2 months [ 47 , 48 ], and one was reported to regain full range of motion and strength as well as axillary nerve sensitivity at 1 year [ 45 ]. The clinical examination was found to be improved in twenty-eight (84.8%) patients, and one (3%) individual had no residual pain but increased weakness at the 3-month follow-up [ 41 ].…”

“…Among them, 36 (61.0%) patients received a mRNA vaccine (24 with BNT162b2, Pfizer, 10 with mRNA-1273, Moderna) [22,[24][25][26][27]29,30,34,[36][37][38][39][40][41][45][46][47][48]50,51,53,56,60] and 18 (30.5%) received a viral vector vaccine (15 with AstraZeneca, 2 This systematic review included 30 articles and 10 meeting abstracts [52][53][54][55][56][57][58][59][60][61] reporting on 59 cases. Among them, 36 (61.0%) patients received a mRNA vaccine (24 with BNT162b2, Pfizer, 10 with mRNA-1273, Moderna) [22,[24][25][26][27]29,30,34,[36][37][38][39][40][41][45]…”

“…Prior studies have demonstrated that the notion of “rechallenge”, typically employed in the evaluation of causality in pharmaceuticals, has proven helpful for specific vaccine incidents, such as GBS following tetanus toxoid vaccination, where GBS occurred on three distinct occasions in a single patient within a few weeks of tetanus toxoid administration [ 20 ]. In patients receiving mRNA vaccines, two cases presented with PTS symptoms, aggravated by the second dose [ 37 , 45 ]. In another case, PTS recurred after a subsequent influenza vaccine, administered six months later; the exact symptoms returned, but with reduced intensity, and disappeared spontaneously after a week [ 60 ].…”