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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while considered a respiratory illness, is associated with a wide range of neurological manifestations, with severity ranging from transient deficit to permanent disability and death. These neurological manifestations can be divided into central nervous system complications, which include cerebrovascular disease and encephalopathies, and peripheral nervous system complications, which involve the muscle (i.e. muscle injuries, myositis, and peripheral and cranial neuropathies). Complement overactivation has been observed clinically in many studies and is hypothesized to be involved in a variety of pathogenic mechanisms of SARS-CoV-2 infection. These include endothelial damage, thrombosis and hyperinflammation, all of which are completely interconnected and integrated. This article broadly describes the diverse neurological effects of coronavirus disease 2019 and delves into the current literature available on complement in this context.

Background: To investigate the association of optic neuritis (ON) after the COVID-19 vaccines. Methods: Cases of ON from Vaccine Adverse Event Reporting System (VAERS) were collected and divided into the prepandemic, COVID-19 pandemic, and COVID-19 vaccine periods. Reporting rates were calculated based on estimates of vaccines administered. Proportion tests and Pearson χ2 test were used to determine significant differences in reporting rates of ON after vaccines within the 3 periods. Kruskal–Wallis testing with Bonferroni-corrected post hoc analysis and multivariable binary logistic regression was used to determine significant case factors such as age, sex, concurrent multiple sclerosis (MS) and vaccine manufacturer in predicting a worse outcome defined as permanent disability, emergency room (ER) or doctor visits, and hospitalizations. Results: A significant increase in the reporting rate of ON after COVID-19 vaccination compared with influenza vaccination and all other vaccinations (18.6 vs 0.2 vs 0.4 per 10 million, P < 0.0001) was observed. However, the reporting rate was within the incidence range of ON in the general population. Using self-controlled and case-centered analyses, there was a significant difference in the reporting rate of ON after COVID-19 vaccination between the risk period and control period (P < 0.0001). Multivariable binary regression with adjustment for confounding variables demonstrated that only male sex was significantly associated with permanent disability. Conclusions: Some cases of ON may be temporally associated with the COVID-19 vaccines; however, there is no significant increase in the reporting rate compared with the incidence. Limitations of this study include those inherent to any passive surveillance system. Controlled studies are needed to establish a clear causal relationship.

Purpose. To report a case of Streptococcus mitis oralis (S. mitis/oralis) corneal ulcer in a patient with a possible preventable cause. Methods. Cultures were obtained from a 64-year-old woman with a 3.5   mm × 5   mm corneal ulcer with hypopyon in the left eye. Results. Culture reports demonstrated the growth of S. mitis/oralis, a commensal organism of the oral flora. Fortified vancomycin 5% eye drops were started, and the patient was counseled on the rarity of the bacteria as an etiology of corneal ulcers. On the return visit, the patient, who works in a doctor’s office, volunteered information that the preservative free artificial tear vials that she used were difficult to open because of her hand deformity due to rheumatoid arthritis; thus, she had to bite the vials open. Conclusions. S. mitis/oralis is an organism commonly found in the mouth but is rarely found in the eye. We report a unique case of an immunocompromised patient with rheumatoid arthritis, severe dry eye, and a history of multiple episodes of keratolysis, who developed a corneal ulcer from a rare pathogen, with a plausible and preventable route of infection.

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