"... [authors] describe a case of ATM [acute transverse myelitis] with a fatal prognosis following vaccination with an mRNA-based COVID-19 vaccine (BNT162b2, Pfizer)and review the clinical features of ATM in COVID-19 vaccine recipients.
[The] patient presented with progressive paraplegia, hypoesthesia in both lower limbs, and urinary retention following a two-day history of vertigo and vomiting after receiving the second dose of the BNT162b2 vaccine. Based on the Brighton case definition for myelitis, [the] patient was diagnosed with myelitis with level 2 diagnostic certainty. Treatment with continuous steroid therapy did not improve his neurological symptoms. Subsequently, he died of a poor general condition.
... The remarkable difference between the previously reported cases [ofATM] and ours was the prognosis after treatment. Both our patient and the previously reported patients were treated with immunological therapies. The previously reported patients had recovery of neurological symptoms after treatment; however, our patient did not respond to treatment, and he died 58 days after receiving the second dose of the BNT162b2 vaccine... Although the precise pathophysiologic mechanisms of the neurological complications following BNT162b2 vaccination remain uncertain, an abnormal immune-mediated inflammation has been implicated. This study highlights that ATM after COVID-19 vaccination may be refractory to conventional steroid therapy, and that ATM in COVID-19 vaccine recipients could have a poor prognosis."
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