Case Report: Multiple Sclerosis Relapses After Vaccination Against SARS-CoV2: A Series of Clinical Cases

Abstract

Objective: To describe a temporal association between COVID-19 vaccine administration and multiple sclerosis (MS) relapses. Methods: This case series study was collected in four MS Centres in Central Italy, using data from 16 MS patients who received COVID-19 vaccination and presented both clinically and radiologically confirmed relapses between March and June 2021. We collected patients' relevant medical history, including demographics, MS clinical course, disease-modifying treatment (DMT) received (if applicable), and data from MRI scans obtained after the COVID-19 vaccination. Results: Three out of 16 patients received a diagnosis of MS with a first episode occurring after COVID-19 vaccination; 13 had already a diagnosis of MS and, among them, 9 were on treatment with DMTs. Ten patients received BNT162b2/Pfizer-BioNTech, 2 patients mRNA-1273/Moderna, and 4 patients ChAdOx1 nCoV-19/AstraZeneca. All MS relapses occurred from 3 days to 3 weeks after receiving the first dose of the COVID-19 vaccination or the booster. All patients had evidence of radiological activity on MRI. Discussion: Clinical and radiological findings in these cohort of MS patients confirmed disease re/activation and suggested a temporal association between disease activity and COVID-19 vaccination. The nature of this temporal association, whether causative or incidental, remains to be established.

Keywords: COVID-19 vaccine; MRI activity; SARS-CoV2 infection; adverse event; lesions; multiple sclerosis relapse.

Figure 1

New MRI lesions associated with the MS episodes occurred after ChAdOx1 nCoV-19 (AZD12222), mRNA-1273, Moderna and BNT162b2, Pfizer/BioNTech vaccine. The lesions are shown on T2 weighted images or on post-contrast T1 weighted images and are indicated by yellow arrows. (A) Case 1: C3 lesion; (B) Case 2: new enhancing lesion in corpus callosum and multiple white matter unenhanced lesions in periventricular areas and in the mesial occipital lobe; (C) Case 3: new enhancing lesion in the thoracic cord; (D) Case 4: multiple hyperintense lesions in the supra and infratentorial white matter, four of which are with contrast enhancement; (E) Case 5: new brain lesion with contrast enhancement. (F) Case 6: enhancing bulbar lesion; (G) Case 7: C3 lesion with contrast enhancement; (H) Case 8: new brain enhancing lesion; (I) Case 9: a new contrast enhancing lesion in the mesencephalon. (L) Case 10: new enhancing brain lesion. (M) Case 11: enhancing brain lesion with conspicuous oedema; (N) Case 12: a new active lesion with ring enhancement in the left frontal white matter. (O) Case 13: three new brain enhancing lesions, one of which is indicated by the arrow; (P) Case 14: three new enhancing lesions in the left temporal lobe and one, indicated here, in the left centrum semiovale; (Q) Case 15: two ring-enhancing lesions localized in the white matter adjacent to the left frontal horn and in the left middle periventricular region. (R). Case 16: new enhancing lesions, one of which is tumefactive, localized in the white matter of the left centrum semiovale.