Dados do Trabalho

Título

Autoimune Encephalitis after 1st dose of Pfizer COVID-19 vaccine in a 16-year-old patient: case report

RESUMO

Presentation: A 16-year-old male patient, from a countryside city in Amazonas, was referred to our service reporting sudden onset of paresthesia and paraparesis in the lower limbs, associated with chest tremors, dyspnea and anterograde amnesia one day after receiving his 1st dose of Pfizer COVID-19 vaccine. When admitted to the hospital, he had an GCS of 14, spasms in the abdominal and thoracic muscles and plastic hypertonia in the left upper limb. After admission, he presented with generalized myoclonic seizures without loss of consciousness associated with constant high-pitched tinnitus bilaterally and his neurological examination showed grade 3 reflexes in right biceps and patellar, left brachioradialis and triceps bilaterally, in addition to hypoesthesia in the left hemibody and bilateral nystagmus. The patient was treated with phenytoin, which was later replaced by sodium valproate, associated with diazepam and empiric acyclovir. Given the information presented, the hypothesis of autoimmune encephalitis was raised. Due to logistical difficulties caused by the pandemic, the patient underwent only a cranial magnetic resonance imaging 18 days after admission, where no changes were evidenced. After an increase in the frequency of seizures, he was referred to the ICU for treatment with plasmapheresis. One month after his admission, he was discharged using levetiracetam and the case was followed up in our outpatient service. Discussion: Autoimmune encephalitis presents as a range of acute neurological symptoms, which can include headaches, altered mental status, seizures and autonomic and movement disorders, and can or can not be associated with a paraneoplastic syndrome. Its treatment is based on immunosuppressive therapies such as steroids, immunoglobulins or plasmapheresis, favoring the patient's prognosis in case of an early diagnosis. Final comments: In this case, we bring a severe and rare presentation of post-vaccination encephalitis. It is essential to shed light on such adverse reactions, not to question the safety of the vaccine campaign, but to show that treating them effectively can enable complete patient rehabilitation, in addition to contributing to the formation of more accurate epidemiological evidence about neurological disorders related to COVID-19 vaccination.

Palavras Chave

Autoimmune Encephalitis, Vaccine, COVID-19