Dados do Trabalho

Título

Autonomic neuropathy following COVID-19 vaccination.

RESUMO

Case presentation

Patient, male, 24 years, presented in emergency service following a 4-day history of intense abdominal pain with associated nausea, after the first dose of a mRNA COVID-19 vaccine. Upon interrogation, he stated that he had not defecated for 2 days and reported having difficulties urinating.
On physical examination, he was alert, with normoactive reflexes, without appendicular and facial motor deficits, and apparent hypoesthesia in his left lower limb, with normal deep sensitivity.
In a later evaluation, he reported sporadic urinary retention, requiring effort to initiate diuresis. He denied nausea. Mentioned intestinal colic with diarrhea and hypotension, reporting episodes of dizziness when standing in orthostasis. Laboratory tests showed no changes.
Electroneuromyography showed absence of plantar cutaneous reflex in the right foot region, which is compatible with suspicion of autonomic neuropathy.
After 10 days from the onset of symptoms, the patient evolved with clinical improvement and normal, pain-free urination.

Discussion

Autonomic neuropathy is a condition where the nervous connections of the autonomic nervous system are affected, causing denervation that has repercussions on various body systems, such as the gastrointestinal, urinary and cardiovascular. There are several associated etiologies, as well as different pathophysiologies.
The current literature already has published case studies associating the COVID-19 mRNA vaccine with autonomic dysfunction. However, most cases mention Guillain-Barré Syndrome, an autoimmune disease, in which autonomic neuropathy is a secondary complication, not the main symptom.
Primary autonomic dysfunctions can occur as an autoimmune complication of viral infections, including being associated with the post-COVID-19 syndrome itself. As an adverse post-vaccination effect, it has already been reported in studies after immunization with the quadrivalent HPV vaccine, but with regard to COVID-19 vaccines, so far only two cases have been reported worldwide, one with a recombinant vaccine and another with a mRNA vaccine.

Final Comments

The patient's clinical history together with the complementary exams performed confirmed the diagnosis of autonomic neuropathy, which by the chronology of the facts can be attributed to a rare complication of the vaccination. Furthermore, the authors believe that further studies on the comorbidities of vaccination for COVID-19 will may explain its complete pathophysiology.

Palavras Chave

autonomic neuropathy; dysautonomia; COVID-19; vaccine