Acute Fulminant Demyelination after the COVID-19 Vaccine: A Case Report and Review of the Literature
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Abstract Introduction COVID-19 vaccination campaigns have successfully limited the spread of the disease and reduced its severity. Neurological side effects of COVID-19 vaccines are rare. To the best of our knowledge, only a few case reports have shown an association between the COVID-19 vaccine and the development of probable acute fulminant demyelination. Case Presentation In this case report, we investigated and documented a temporal association suggesting a possible causal link between COVID-19 vaccination and acute fulminant demyelination, supported by a review of the existing literature. We describe the case of a 30-year-old female who experienced severe neurological symptoms, including memory loss, disorientation, paranoia, hallucinations, and urinary incontinence, just 3 days after receiving the Pfizer-BioNTech COVID-19 vaccine booster. Magnetic resonance imaging (MRI) revealed multiple T2 lesions with contrast enhancement consistent with demyelination. The condition rapidly progressed to somnolence, disorientation, aphasia, and quadriparesis. Treatment was initiated with pulse intravenous methylprednisolone, plasma exchange, prednisolone, natalizumab, and high-dose cyclophosphamide, resulting in disease stabilization, which was complicated by febrile neutropenia and meningitis. Fortunately, gradual improvement was observed, with MRI showing no new lesions on the follow-up imaging. Conclusion The literature review revealed limited case reports on COVID-19 vaccine-indu
Abstract
Abstract Introduction COVID-19 vaccination campaigns have successfully limited the spread of the disease and reduced its severity. Neurological side effects of COVID-19 vaccines are rare. To the best of our knowledge, only a few case reports have shown an association between the COVID-19 vaccine and the development of probable acute fulminant demyelination. Case Presentation In this case report, we investigated and documented a temporal association suggesting a possible causal link between COVID-19 vaccination and acute fulminant demyelination, supported by a review of the existing literature. We describe the case of a 30-year-old female who experienced severe neurological symptoms, including memory loss, disorientation, paranoia, hallucinations, and urinary incontinence, just 3 days after receiving the Pfizer-BioNTech COVID-19 vaccine booster. Magnetic resonance imaging (MRI) revealed multiple T2 lesions with contrast enhancement consistent with demyelination. The condition rapidly progressed to somnolence, disorientation, aphasia, and quadriparesis. Treatment was initiated with pulse intravenous methylprednisolone, plasma exchange, prednisolone, natalizumab, and high-dose cyclophosphamide, resulting in disease stabilization, which was complicated by febrile neutropenia and meningitis. Fortunately, gradual improvement was observed, with MRI showing no new lesions on the follow-up imaging. Conclusion The literature review revealed limited case reports on COVID-19 vaccine-induced central nervous system demyelination, with no consensus on its link to the Marburg variant of multiple sclerosis. This case highlights the heterogeneity of MS pathogenesis, risk factors, and challenges in managing severe clinical deterioration. Given the rare nature of Marburg MS, early detection and management of the disease lead to a better outcome and prognosis.