Small Fiber Neuropathy Associated With the Moderna SARS-CoV-2 Vaccine

Abstract

Efforts of controlling viral transmission began soon after the first cases of coronavirus disease 2019 (COVID-19) infections were identified. Initial efforts were related to contact precautions, hand hygiene, and maskwearing; however, it was soon evident that a robust global immunization drive was the most effective way to curb disease transmission. In the United States, the first doses of COVID-19 vaccines were rolled out soon after the FDA granted emergency use authorization for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. What this also meant was that many of the routine phases that any new drug or vaccine goes through before being released publicly were bypassed. Over the past two years, various side effects and reactions have been seen after COVID-19 vaccine administration, the most common being local injection site events (e.g., pain, redness, swelling) and systemic effects (e.g., fatigue, headaches, myalgias). We report the case of a 64-year-old female who developed bilateral lower extremity numbness and tingling within weeks of receiving the third dose of Moderna SARS-CoV-2 vaccine. The patient underwent extensive testing to ascertain the diagnosis. She had negative autonomic testing and normal nerve conduction study/electromyography (EMG), which did not reveal large fiber neuropathy. Eventually, the patient underwent a skin biopsy, which revealed small fiber neuropathy. This case report highlights the importance of keeping a broad differential for rare side effects, such as small fiber neuropathy, that are currently being seen and reported in the literature.

Strategies for the Management of Spike Protein-Related Pathology

“…It should however be recognized that there is a significant overlap between the symptoms and features of the long Covid syndrome [167] and the post-Covid-Vaccine Syndrome [168]. However, a number of clinical features appear to be distinctive of the post-Covid vaccine syndrome; most notably, severe neurological symptoms (particularly small fiber neuropathy) appears to be more common following vaccination [169][170][171]. To complicate matters further, patients with long Covid are often vaccinated [172], making the issue of definition more difficult.…”

Small fiber neuropathies: expanding their etiologies

“…In addition, various auto-antibodies have been linked to SFN, in the absence of systemic diseases [15 ▪ ,16 ▪▪ ,17 ▪▪ ]. Besides, postinfectious and postvaccination cases of SFN have been described, in which immune-mediated mechanisms are supposed to be causative [18 ▪ ,19 ▪ ,20 ▪ ,21 ▪ ,22 ▪ ,23 ▪ ,24 ▪ ,25 ▪ ,26 ▪ ].…”

“…Not only COVID-19 itself is associated with the development of SFN, but also post COVID-19 vaccination, sensory and autonomic complaints caused by skin biopsy proven SFN have been described [24 ▪ ,25 ▪ ,26 ▪ ]. Within one month after administration, both virus vector vaccines and mRNA vaccines resulted in neuropathic and autonomic symptoms.…”

Small Fiber Neuropathy Triggered by COVID-19 Vaccination: Association with FGFR3 Autoantibodies and Improvement during Intravenous Immunoglobulin Treatment

“…Although the COVID-19 vaccination has helped protect many against the COVID-19 virus, the vaccine has been associated with some complications. There are published patient cases of COVID-19 infection and Pfizer and Moderna vaccine administration causing neurological conditions including Guillain-Barre syndrome, transverse myelitis, and small fiber neuropathy [1][2][3][4][5][6][7][8]. The mechanism underlying the development of small fiber neuropathy after COVID-19 vaccination is not known.…”