Post-Vaccinal Encephalitis with Early Relapse after BNT162b2 (COMIRNATY) COVID-19 Vaccine: A Case Report

Abstract

We describe the case of a 72-year-old man who received the first dose of the BNT162b2 (COMIRNATY) vaccine against COVID-19 on 18 May 2021, and the second dose on 9 September 2021. One day after receiving the first dose, he cursed with malaise, headache, fever, confusion, aggressiveness, and gait alterations. We performed serum and cerebrospinal fluid (CSF) tests (finding elevated proteins in CSF) with negative results for infectious, systemic, and neoplastic causes. We performed brain nuclear magnetic resonance imaging (MRI), finding circumscribed encephalitis at the anterior frontal and bilateral temporal lobes. We were unable to perform a panel of antineuronal antibodies. The patient was readmitted due to early clinical relapse four days after receiving his second dose. We found sequelae lesions at the frontal level but with new demyelinating lesions at the left temporal level in brain MRI. We indicated methylprednisolone, and he presented a favorable improvement. We report an encephalitis case of probable autoimmune etiology after vaccination with BNT162b2, which presented early clinical relapse after receiving the second dose and presented a favorable response to methylprednisolone.

Encephalitis following COVID-19 Vaccination: A Systematic Review

“…These include functional neurological disorder symptoms, such as altered mental status, autoimmune encephalitis (AE), acute disseminated encephalomyelitis (ADEM), dizziness, myalgia, fatigue, cognitive impairment, gait instability, facial palsy, Guillain–Barré syndrome (GBS), convulsions, strokes, transverse myelitis, chronic fatigue syndrome, and acute encephalopathy [ 9 , 10 ]. Recently, major neurological complications indicative of vaccination-related autoimmune encephalitis and acute encephalitis after the first dose of mRNA COVID-19 vaccines were reported [ 11 , 12 , 13 , 14 , 15 ]. Notably, acute disseminated encephalomyelitis (ADEM) was consistently reported after the viral vector-based vaccines or inactivated viral vaccine (AstraZeneca, Sputnik V, Sinopharm) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Autoantibody-negative but probable pediatric autoimmune encephalitis following COVID-19 vaccination: A case report

“…A reasonable number of possible AE cases have been reported following COVID-19 vaccination, mainly in adults. ( Samim et al, 2022 , Li et al, 2022 , Vences et al, 2022 , Gao et al, 2022 , Ahn et al, 2022 , Albsheer et al, 2022 , Gelener et al, 2022 ). Because of the temporal association between the vaccination and disease onset, and the absence of another identifiable cause, the vaccination may have been the trigger for AE in the present case.…”

Can COVID-19 Vaccines Induce Premature Non-Communicable Diseases: Where Are We Heading to?

“…The adverse events included VITT (n = 3), CNS demyelinating diseases (n = 8), inflammatory peripheral neuropathies (n = 4), myositis (n = 3), myasthenia (n = 1), limbic encephalitis (n = 1), and giant cell arteritis (n = 1) [ 155 ]. One instance of limbic encephalitis, one case of opsoclonus myoclonus ataxia syndrome, and three cases of acute disseminated encephalomyelitis were found in a comprehensive investigation conducted in Kerala, India [ 203 ].…”

“…A 57-year-old Asian lady with hypertension was documented in a case study [ 203 ]. She had had myalgia after receiving her first dose of the ChAdOx1 nCoV-19 vaccine, and after receiving her second dose, she developed autoimmune encephalitis (AE) [ 204 ].…”

“…Furthermore, GBS appears to occur more frequently in response to immunization with the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines than with mRNA-based COVID-19 vaccines [ 218 ]. Although the number of reported actual cases of GBS after vaccination with the ChAdOx1 nCoV-19 vaccine is rather low [ 203 , 219 , 220 , 221 , 222 , 223 , 224 ], the quality of sleep might be affected in individuals with post-vaccination GBS due to persistent pain during the night [ 224 ].…”