Index Entries

Annika Kits, Mattia Russel Pantalone, Christopher Illies, Aleksandra Antovic, Anne-Marie Landtblom, and Ellen Iacobaeus
November 30, 2022
Vaccines
Karolinska University Hospital (Sweden)

"Introduction

... In this case study, we report a patient that presented with AHEM [acute hemorrhagic encephalomyelitis], systemic venous thromboembolism, and subsequent presence of moderate/high levels of aPL [antiphospholipid] antibodies, indicating a possible APS [antiphospholipid syndrome], following the second Pfizer-BioNTech COVID-19 vaccination. The case illustrates the diagnostic and therapeutic challenges in a patient with fulminant progression of CNS [central nervous system] inflammation and thromboembolism and complicating preceding autoimmune disease, immunosuppressive treatment and vaccination.

Case Description

A 53-year-old man developed confusion and unconsciousness over a few hours and presented at the emergency room with a Glascow Coma Scale of 7, agitation, and snoring... Neurological examination revealed anisocoria, right side miosis, bilateral absence of pupillary light reflex, and reduced voluntary movements in the left arm and leg. The patient was afebrile without clinical or laboratory signs of infection. He was intubated and admitted to the intensive care unit...

Conclusions

AHEM is a life-threatening condition with diagnostic difficulties for which early recognition and treatment initiation is crucial to improve prognosis. The current case with detection of aPL antibodies and concomitant multiple thromboembolic events point out the importance of testing for a possible APS and aPL antibodies in patients with severe CNS neuroinflammatory conditions. High surveillance for the occurrence of thromboembolic events and early consultation with coagulation specialists are emphasized.
 
The temporal correlation with COVID-19 vaccination along with previous reports of ADEM onset after COVID-19 vaccination, may suggest a possible causal relationship although our report does not provide evidence for this."
document
adverse events,clinical cases,COVID-19,deaths,demyelination,mRNA,neurological disorders,vaccines,vascular system issues