Small fiber neuropathy as a complication of SARS-CoV-2 vaccinations

Abstract

Generally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations are not free of side effects. A rarely reported adverse reaction to SARS-CoV-2 vaccinations is small fiber neuropathy (SFN). Here, we present three patients with SFN after the second dose of messenger ribonucleic acid-based SARS-CoV-2 vaccines. Data for this study were collected via the self-made platform “Pubbly” for reporting side effects of SARS-CoV-2 vaccinations. Three patients with post-SARS-CoV-2 vaccination SFN were identified: a 40 yo Caucasian female (patient 1), a 52 yo Caucasian female (patient 2), and a 32 yo Caucasian female (patient 3). Patient 1 complained about fatigue, dizziness, flushing, palpitations, diarrhea, muscle weakness, and gait disturbance 10 days after the second Pfizer jab. Patient 2 reported dizziness, balance problems, brain fog, palpitations, dysphagia, and sleep problems. Patient 3 complained about profound fatigue, brain fog, vertigo, pre-syncopal sensations, hair loss, chest pain, dyspnea, palpitations, paresthesias, irregular menstrual cycles, muscle weakness, and hives 1 day after the second Moderna dose. All three patients underwent skin biopsy upon which SFN was diagnosed. Patient 1 profited from immunoglobulins, but patient 2 did not require any treatment. Symptoms in patient 3 resolved upon symptomatic treatment. Despite treatment, patient 1 did not completely recover. SFN can be a rare side effect of SARS-CoV-2 vaccinations. Post-SARS-CoV-2 vaccination SFN can be mild or severe and may or may not require treatment. Post-SARS-CoV-2 vaccination SFN is most likely immune-mediated as it responds to intravenous immunoglobulins.

Small fiber neuropathy with long-term, multifocal paresthesias after a SARS-CoV-2 vaccination

“… 2 There is increasing evidence that SARS-CoV-2 vaccinations can also cause SFN ( Table 1 ). 3 , 4 , 5 , 6 , 7 , 8 , 9 A patient who developed isolated, multifocal, acral sensory symptoms without pain or autonomic dysfunction for months shortly after SARS-CoV-2 vaccination was not reported.…”

“… 19 multifocal paresthesias [index case] 40 f BPV 2. 10 DN, flushing, diarrhea, MW, GD 4 52 f MOV 2. 17 DN, vertigo, brain fog, palpitations, dysphagia, insomnia 4 32 f MOV 2.…”

“… 10 DN, flushing, diarrhea, MW, GD 4 52 f MOV 2. 17 DN, vertigo, brain fog, palpitations, dysphagia, insomnia 4 32 f MOV 2. 1 fatigue, brain fog, palpitations, vertigo, MW, SD, hives 4 12 pat.…”

“… 17 DN, vertigo, brain fog, palpitations, dysphagia, insomnia 4 32 f MOV 2. 1 fatigue, brain fog, palpitations, vertigo, MW, SD, hives 4 12 pat. nr nr nr nr POTS, hypohidrosis, tachycardia, Raynaud, SD 5 43 m BPV 1.…”

“…SFN due to SARS-CoV-2 vaccines is increasingly recognized and can occur as pure SFN 8 or in combination with other neurological or non-neurological side effects. 4 Common symptoms of SARS-CoV-2 vaccination-associated SFN are hypoesthesia, thermohypoesthesia, paresthesia, dysesthesia, reduced vibration sense and focal, regional, or whole-body pain. 4 , 5 , 6 , 7 , 8 In addition to sensory disturbances, these patients may develop autonomic abnormalities such as tachycardia, postural tachycardia syndrome (POTS), diarrhea, orthostasis, heat intolerance, hypohidrosis, and palpitations.…”