Case Report: Postvaccination Anti-Myelin Oligodendrocyte Glycoprotein Neuromyelitis Optica Spectrum Disorder: A Case Report and Literature Review of Postvaccination Demyelination

Abstract

Stimulation of the immune response after vaccination can occasionally result in adverse effects, including demyelination of the central nervous system. The most common presentation of postvaccination demyelination is acute disseminated encephalomyelitis, but cases of optic neuritis, transverse myelitis, and multiple sclerosis relapses have been reported. More recently, an increasing number of postvaccination neuromyelitis optica spectrum disorder (NMOSD) cases have surfaced in the literature, especially in patients with aquaporin-4 antibodies. In this article, we report an unusual case of myelin oligodendrocyte glycoprotein antibody-related NMOSD after the receipt of multiple vaccines in a first-trimester pregnant woman from Africa. We review the reported cases of postvaccination demyelination in the past decade, with a focus on the relationship between NMOSD and vaccination in patients with aquaporin-4 or myelin oligodendrocyte glycoprotein antibodies. Finally, we discuss the clinical relevance of the present case and similar reported cases as it relates to patient care in the neuroimmunology clinic and identify potential areas for future research.

Keywords: Anti-myelin oligodendrocyte glycoprotein (MOG); Multiple sclerosis (MS); Neuromyelitis optica.

Figure 1.

Axial fluid-attenuated inversion recovery magnetic resonance images (MRIs) of brain and sagittal T2-weighted MRI of cervical spine before treatment Brain MRI shows multifocal large hyperintense lesions involving cortex and subcortical white matter (A), thalami (B), and pons (C) and cervical spine MRI shows a vague longitudinally extensive hyperintense lesion extending from the cervicomedullary junction (continuous with medullary/pontine lesion) to C7 level (D). Arrows point to the abnormal signals in the brain and cervical spinal cord.

Figure 2.

Axial fluid-attenuated inversion recovery magnetic resonance images (MRIs) of brain (A-C) and sagittal T2-weighted MRI of cervical spine (D) after treatment After treatment (47 days after initial MRI), MRIs show resolution of abnormal signals.