Transverse myelitis associated with yellow fever vaccination

Abstract

Yellow fever is a mosquito-borne viral hemorrhagic fever endemic to sub-Saharan Africa and South America associated with significant morbidity and mortality. The use of a live attenuated vaccine can prevent yellow fever, but vaccine-associated neurologic disease has been reported and is a safety concern. We present the case of a previously healthy 35-year-old active-duty man who received the yellow fever vaccine prior to deployment and subsequently developed progressive neurologic dysfunction consistent with transverse myelitis.

Keywords: Transverse myelitis; yellow fever; yellow fever vaccine–associated neurologic disease.

Figure 1.

A representative parasagittal volumetric T2 fluid-attenuated inversion recovery image of the brain demonstrating a few subcentimeter foci of signal abnormality confined to the white matter of the cerebral hemispheres. This is a nonspecific pattern that may be seen as a result of infection and inflammation (as well as prior trauma, migraine-related change, and primary demyelination). There is no evidence of meningitis.

Figure 2.

Three midline sagittal short tau inversion recovery images of the cervical spine obtained throughout the clinical course of this patient. (a) At presentation, the image demonstrates longitudinally extensive signal abnormality in the spinal cord extending from the cervical-medullary junction into the thoracic spinal cord (not completely visualized). (b) Three days later, the cord became more edematous, resulting in further narrowing of the subarachnoid space, and signal abnormality became more evident in the brainstem, particularly the medulla. (c) Seventeen days after presentation, following corticosteroid and plasmapheresis therapy, and correlating with a profound clinical improvement, the image demonstrates nearly completely resolved signal abnormality and resolved edema in the brainstem and spinal cord.