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Case Reports
. 2022 May 18;22(1):185.
doi: 10.1186/s12883-022-02698-y.

Severe disease exacerbation after mRNA COVID-19 vaccination unmasks suspected multiple sclerosis as neuromyelitis optica spectrum disorder: a case report

Lisa Lohmann  1 , Felix Glaser  2 , Gabriel Möddel  2 , Jan D Lünemann  2 , Heinz Wiendl  2 , Luisa Klotz  2
Affiliations
Case Reports

Severe disease exacerbation after mRNA COVID-19 vaccination unmasks suspected multiple sclerosis as neuromyelitis optica spectrum disorder: a case report

Lisa Lohmann et al. BMC Neurol. .

Abstract

Background: Since the beginning of the COVID-19 pandemic and development of new vaccines, the issue of post-vaccination exacerbation or manifestation of demyelinating central nervous system (CNS) disorders has gained increasing attention.

Case presentation: We present a case of a 68-year-old woman previously diagnosed with multiple sclerosis (MS) since the 1980s who suffered a rapidly progressive severe sensorimotor paraparesis with loss of bladder and bowel control due to an acute longitudinal extensive transverse myelitis (LETM) after immunization with the mRNA Pfizer-BioNTech COVID-19 vaccine. Detection of Aquaporin-4-antibodies (AQP4) in both serum and CSF led to diagnosis of AQP4-antibody positive neuromyelitis optica spectrum disorder (NMOSD). Treatment with intravenous corticosteroids and plasmapheresis led to a slight improvement of the patient's symptoms.

Conclusions: Pathogenic mechanisms of post-vaccination occurrence of NMOSD are still unknown. However, cases like this should make aware of rare neurological disorders manifesting after vaccination and potentially contribute to improvement of management of vaccinating patients with inflammatory CNS disorders in the future. So far two cases of AQP4-antibody positive NMOSD have been reported in association with viral vector COVID-19 vaccines. To our knowledge, we report the first case of AQP4-antibody positive NMOSD after immunization with an mRNA COVID-19-vaccine.

Keywords: COVID-19; Case report; MS; NMOSD; Vaccination.

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Conflict of interest statement

LL and FG declare that they have no competing interests. GM received industry-funded travel support from Desitin Arzneimittel, Eisai Pharma, and UCB Pharma, as well as speaking honoraria from UCB Pharma. JDL received speaker fees, research support, and served on advisory boards at the Swiss National Science Foundation, the Swiss Multiple Sclerosis Society, AbbVie, Alexion, ArgenX, Bayer AG, Biogen Inc., Sanofi Genzyme, Merck & Co., Novartis AG, F. Hoffmann-La Roche. HW received honoraria for acting as a member of scientific advisory boards for Biogen, Evgen, Genzyme, MedDay Pharmaceuticals, Merck Serono, Novartis, Roche Pharma AG, and Sanofi-Aventis as well as speaker honoraria and travel support from Alexion, Biogen, Cognomed, F. Hoffmann-La Roche Ltd., Gemeinnützige Hertie-Stiftung, Merck Serono, Novartis, Roche Pharma AG, Genzyme, Teva, and WebMD Global. He is acting as a paid consultant for Actelion, Biogen, IGES, Johnson & Johnson, Novartis, Roche, Sanofi-Aventis, and the Swiss rheuma Society. His research is funded by the German Ministry for Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), Else Kröner Fresenius Foundation, Fresenius Foundation, the European Union, Hertie Foundation, NRW Ministry of Education and Research, Interdisciplinary Center for Clinical Studies (IZKF) Muenster and Biogen, GlaxoSmithKline GmbH, Roche Pharma AG, and Sanofi-Genzyme. LK received compensation for serving on scientific advisory boards for Alexion, Genzyme, Janssen, Merck Serono, Novartis, and Roche. She received speaker honoraria and travel support from Bayer, Biogen, Genzyme, Grifols, Merck Serono, Novartis, Roche, Santhera, and Teva. She receives research support from the German Research Foundation, the IZKF Münster, IMF Münster, Biogen, Immunic AG, Novartis, and Merck Serono.

Figures

Fig. 1
Fig. 1
Spinal cord MRI (a) Sagittal T1-weighted + GD image; white arrow indicates GD-enhancement ranging from C3 to C5 (b) Sagittal T2-weighted images; white arrows indicate T2-signal alteration ranging from C4 to T10
See this image and copyright information in PMC

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