Acute disseminated encephalomyelitis following the COVID-19 Vaccine Sinopharm in low- and middle-income country: a case report

Abstract

Introduction and Importance: COVID-19 is a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and various vaccines against it has been developed. Acute Disseminated Encephalomyelitis (AEDM) is a diseases of the central nervous system that cause inflammation and demyelination and manifests as a multi-symptom acute neurological condition. Although infections are usually the cause of ADEM, vaccines may cause 5-10% of cases. Case Presentation: A 40-year-old woman had received 2nd dose of the Sinopharm COVID-19 vaccine four months prior to visit and experienced sudden gait imbalance and vertigo a day after her vaccination; which lasted for more than months. On examination, no signs of skin bruising or bleeding were observed, and her vital signs were within the normal range. On neurological assessment, patient had Glasgow Coma Scale score 14/15(E4V5M5), had normal pupil size and light reaction, normal fundus, normal deep tendon reflexes and bilateral extensor plantar response. Meningeal symptoms were absent, and SARS-CoV-2 RNA tests using NAAT was negative. Development of CNS manifestations during the recovery phase of fever, along with typical MRI findings; the diagnosis of para-infectious ADEM with COVID-19 vaccination was made. After the treatment with Injection methyl prednisolone sodium succinate patient showed improvement. Clinical Discussion: ADEM associated with post-vaccinations is a rare condition. There has been growing evidence that shared epitopes between neuronal proteins and SARS-CoV-2 antigens may trigger autoimmune reactions against the CNS through molecular mimicry as its pathogenesis. Conclusion: We suggest the need of strict vaccine safety monitoring system and post-vaccine monitoring and surveillance.