Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: a Case Report

Kuntz, Stephanie; Saab, Georges; Schneider, Raphaël

doi:10.1007/s42399-022-01213-1

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…The patient with high titre AQP4 IgG had clinical and radiologic features in keeping with a diagnosis of NMOSD. 18 The patient with weak titre AQP4 IgG presented with short segment TM and was positive for MOG IgG (unknown titre as indicated above). This patient received a diagnosis of MOGAD and repeat AQP4 IgG was negative.…”

Section: Resultsmentioning

confidence: 98%

“…4,5 Upon global uptake of COVID-19 vaccines, a number of reports have described various presentations of acute central nervous system (CNS) inflammation in individuals shortly after vaccination. This includes new onset multiple sclerosis (MS), [6][7][8] MS relapse, 6,9 transverse myelitis (TM), 4,[10][11][12][13] myelin oligodendrocyte glycoprotein antibody disease (MOGAD), 14,15 neuromyelitis optica spectrum disorder (NMOSD), 6,[16][17][18] acute disseminated encephalomyelitis (ADEM), [19][20][21] leucine-rich glioma-inactivated protein 1 (LGI1) antibody encephalitis, 22 and seronegative autoimmune limbic encephalitis. 23 Vaccination has long been speculated to increase the risk of CNS inflammatory events, most notably demyelinating diseases such as ADEM.…”

Section: Introductionmentioning

confidence: 99%

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Acute central nervous system inflammation following COVID-19 vaccination: An observational cohort study

et al. 2023

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Background: Reports suggest a potential association between coronavirus disease 2019 (COVID-19) vaccines and acute central nervous system (CNS) inflammation. Objective: The main objective of this study is to describe features of acute CNS inflammation following COVID-19 vaccination. Methods: A retrospective observational cohort study was performed at the BARLO MS Centre in Toronto, Canada. Clinicians reported acute CNS inflammatory events within 60 days after a COVID-19 vaccine from March 2021 to August 2022. Clinical characteristics were evaluated. Results: Thirty-eight patients (median age 39 (range: 20–82) years; 60.5% female) presented within 0–55 (median 15) days of a receiving a COVID-19 vaccine and were diagnosed with relapsing remitting multiple sclerosis (MS) ( n = 16), post-vaccine transverse myelitis ( n = 7), clinically isolated syndrome ( n = 5), MS relapse ( n = 4), tumefactive demyelination ( n = 2), myelin oligodendrocyte glycoprotein antibody disease ( n = 1), neuromyelitis optica spectrum disorder ( n = 1), chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids ( n = 1) and primary autoimmune cerebellar ataxia ( n = 1). Twenty-two received acute treatment and 21 started disease-modifying therapy. Sixteen received subsequent COVID-19 vaccination, of which 87.5% had no new or worsening neurological symptoms. Conclusion: To our knowledge, this is the largest study describing acute CNS inflammation after COVID-19 vaccination. We could not determine whether the number of inflammatory events was higher than expected.

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Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Acute central nervous system inflammation following COVID-19 vaccination: An observational cohort study

et al. 2023

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“…Although this review indicates that there is a plausible association between the COVID-19 vaccination and NMOSD, the number of cases appears to be rare, and vaccination is still strongly encouraged. Currently, epidemiological and clinical data suggests that the benefits of vaccination conferred to both the individual and the public supersedes the possible risk of NMOSD associated with vaccination (34,71). Furthermore, given the large number of patients that have received the COVID-19 vaccination, only a few reports have documented NMOSD manifestations following the vaccine, indicating that this is an uncommon occurrence.…”

Section: Discussionmentioning

confidence: 99%

New onset or relapsing neuromyelitis optica temporally associated with SARS-CoV-2 infection and COVID-19 vaccination: a systematic review

Harel¹,

Gorman²,

Wallin³

2023

Front. Neurol.

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BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a rare chronic neuroinflammatory autoimmune condition. Since the onset of the COVID-19 pandemic, there have been reports of NMOSD clinical manifestations following both SARS-CoV-2 infections and COVID-19 vaccinations.ObjectiveThis study aims to systematically review the published literature of NMOSD clinical manifestations associated with SARS-CoV-2 infections and COVID-19 vaccinations.MethodsA Boolean search of the medical literature was conducted between December 1, 2019 to September 1, 2022, utilizing Medline, Cochrane Library, Embase, Trip Database, Clinicaltrials.gov, Scopus, and Web of Science databases. Articles were collated and managed on Covidence® software. The authors independently appraised the articles for meeting study criteria and followed PRISMA guidelines. The literature search included all case reports and case series that met study criteria and involved NMOSD following either the SARS-CoV-2 infection or the COVID-19 vaccination.ResultsA total of 702 articles were imported for screening. After removing 352 duplicates and 313 articles based on exclusion criteria, 34 articles were analyzed. A total of 41 cases were selected, including 15 patients that developed new onset NMOSD following a SARS-CoV-2 infection, 21 patients that developed de novo NMOSD following COVID-19 vaccination, 3 patients with known NMOSD that experienced a relapse following vaccination, and 2 patients with presumed Multiple Sclerosis (MS) that was unmasked as NMOSD post-vaccination. There was a female preponderance of 76% among all NMOSD cases. The median time interval between the initial SARS-CoV-2 infection symptoms and NMOSD symptom onset was 14 days (range 3–120 days) and the median interval between COVID-19 vaccination and onset of NMO symptoms was 10 days (range 1 to 97 days). Transverse myelitis was the most common neurological manifestation in all patient groups (27/41). Management encompassed acute treatments such as high dose intravenous methylprednisolone, plasmapheresis, and intravenous immunoglobulin (IVIG) and maintenance immunotherapies. The majority of patients experienced a favorable outcome with complete or partial recovery, but 3 patients died.ConclusionThis systematic review suggests that there is an association between NMOSD and SARS-CoV-2 infections and COVID-19 vaccinations. This association requires further study using quantitative epidemiological assessments in a large population to better quantify the risk.

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“…NMOSD have been rarely reported in association with COVID-19 vaccination. 29,30 MOGAD has been reported in a considerable number of cases after SARS-CoV-2 infection 31 The probable pathogenesis involves a post-infectious immune-mediated phenomenon rather than direct viral neurotropism. MOGAD triggered by infection encompasses molecular mimicry, spreading of antigenic epitope, bystander activation followed by polyclonal activation of Bcells.…”

Section: Discussionmentioning

confidence: 99%

Spectrum of Neurological Adverse Events Following COVID-19 Vaccination: An Observational Study From a Tertiary Care Centre of Eastern India

CHAKRABORTY,

RAY,

PANDIT

et al. 2023

Preprint

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Background: As the world tends to recover from the crisis created by the COVID-19 pandemic, vaccines have served as one of the most valuable tools of combat and large-scale immunization has helped to tide over the catastrophe. However, several reports of post -vaccination neurological complications around the globe have surfaced up in recent literature. This study was conducted with an aim to describe the spectrum of neurological ailments requiring hospitalization following COVID-19 vaccination.Methods: An ambispective observational study was carried out from March 2021 to February 2022 at a tertiary care institute with 25 patients who satisfied the inclusion criteria of a new onset neurological illness requiring hospitalization within 4 days to 42 days of vaccination. The patients were duly followed upto months after discharge.Results: The median age of the sample was 36 years and the median latency of onset of neurological events was 14 days. Guillain-Barré syndrome was documented in 11 patients; majority were acute motor axonal neuropathy (45.45%) followed by acute inflammatory demyelinating polyradiculoneuropathy (36.36%) and acute motor sensory axonal neuropathy (18.18%). Central nervous system demyelination was reported in 9 patients; two patients had acute disseminated encephalomyelitis, 2 patients were diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease, one patient with aquaporin-4 positive neuromyelitis optica spectrum disorder , and the rest were labelled as seronegative central nervous system demyelination. Vascular events were noted in 5 patients comprising of 2 cases each of cerebral venous sinus thrombosis and intracerebral hemorrhage and a case of Moyamoya angiopathy. All patients were conservatively managed and had a complete to partial recovery suggestive of a favorable outcome after 3 months. Conclusion: The pathomechanisms of post -vaccination neurological complications is yet to be elucidatedand any causal association attributable to vaccination warrants further research. Compared to the enormity of the vaccinated population, the adverse effects are miniscule to hinder and discourage vaccination.

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Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: a Case Report

Cited by 6 publications

References 12 publications

Acute central nervous system inflammation following COVID-19 vaccination: An observational cohort study

Acute central nervous system inflammation following COVID-19 vaccination: An observational cohort study

New onset or relapsing neuromyelitis optica temporally associated with SARS-CoV-2 infection and COVID-19 vaccination: a systematic review

Spectrum of Neurological Adverse Events Following COVID-19 Vaccination: An Observational Study From a Tertiary Care Centre of Eastern India

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