Post COVID-19 infection neuromyelitis optica spectrum disorder (NMOSD): A case report-based systematic review

Mirmosayyeb, Omid; Ghaffary, Elham Moases; Bagherieh, Sara; Barzegar, Mahdi; Dehghan, Mohammad Sadegh; Shaygannejad, Vahid

doi:10.1016/j.msard.2022.103697

Cited by 23 publications

(26 citation statements)

References 63 publications

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“…virus, Epstein-Barr virus, herpes simplex virus, cytomegalovirus, and Mycobacterium pneumoniae as well as tuberculosis [2]. NMOSD has also been reported to be associated with coronavirus disease 2019 (COVID-19) [2].…”

Section: Casementioning

confidence: 99%

“…Currently, NMOSD is diagnosed based on the presence of anti-AQP4-IgG with at least one core clinical characteristic: optic neuritis, acute myelitis, area postrema syndrome, or acute brainstem syndrome [ 1 ]. Although the precise pathogenesis of NMOSD is not yet understood, NMOSD has been reported following many infectious diseases, including those caused by varicella-zoster virus, Epstein–Barr virus, herpes simplex virus, cytomegalovirus, and Mycobacterium pneumoniae as well as tuberculosis [ 2 ]. NMOSD has also been reported to be associated with coronavirus disease 2019 (COVID-19) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the precise pathogenesis of NMOSD is not yet understood, NMOSD has been reported following many infectious diseases, including those caused by varicella-zoster virus, Epstein–Barr virus, herpes simplex virus, cytomegalovirus, and Mycobacterium pneumoniae as well as tuberculosis [ 2 ]. NMOSD has also been reported to be associated with coronavirus disease 2019 (COVID-19) [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Since the outbreak of COVID-19, the disease or its vaccination has affected the bronchopulmonary system and can manifest in nearly all compartments of the body, including the central and peripheral nervous systems [ 3 ]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an immune trigger associated with bystander activation, epitope spreading, and molecular mimicry [ 2 ]. Subsequently, anti-AQP4-IgG antibodies and inflammatory cells infiltrating susceptible hosts can cause NMOSD [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an immune trigger associated with bystander activation, epitope spreading, and molecular mimicry [ 2 ]. Subsequently, anti-AQP4-IgG antibodies and inflammatory cells infiltrating susceptible hosts can cause NMOSD [ 2 ]. Regarding the peripheral nervous system, an association between SARS-CoV-2 and polyradiculitis has been reported [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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A Case Presenting with Neuromyelitis Optica Spectrum Disorder and Infectious Polyradiculitis Following BNT162b2 Vaccination and COVID-19

et al. 2022

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A 37-year-old woman presented with paraparesis and paresthesia in both legs 19 and 3 days after BNT162b2 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, respectively. Cerebrospinal fluid (CSF) analysis, nerve conduction study, electromyography, magnetic resonance imaging, and autoantibody tests were performed. Neurological examination showed hyperesthesia below the T7 level and markedly impaired bilateral leg weakness with absent deep tendon reflexes on the knees and ankles. CSF examination revealed polymorphonuclear dominant pleocytosis and elevated total protein levels. Enhancement of the pia mater in the lumbar spinal cord and positive sharp waves in the lumbar paraspinal muscles indicated infectious polyradiculitis. In contrast, a high signal intensity of intramedullary spinal cord on a T2-weighted image from C1 to conus medullaris and positive anti-aquaporin-4 antibody confirmed neuromyelitis optica spectrum disorder (NMOSD). The patient received intravenous methylprednisolone, antiviral agents, and antibiotics, followed by a tapering dose of oral prednisolone and azathioprine. Two months after treatment, she was ambulatory without assistance. The dual pathomechanism of NMOSD triggered by coronavirus disease 2019 (COVID-19) vaccination and polyradiculitis caused by SARS-CoV-2 infection may have caused atypical clinical findings in our patient. Therefore, physicians should remain alert and avoid overlooking the possibilities of diverse mechanisms associated with neurological manifestations after SARS-CoV-2 infection and COVID-19 vaccination.

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Section: Casementioning

confidence: 99%