Dados do Trabalho

Título

Case report of a 59-year-old patient with transverse myelitis, cerebellar syndrome and ADEM after vaccine for covid in Brazilian Amazon.

RESUMO

Presentation: A 59-year-old patient from Manaus, Amazonas, seeks emergency care at an emergency hospital after the fifth day of AstraZeneca vaccine for COVID-19, presenting progressive, symmetrical and ascending loss of strength in the lower limbs with 3 days of evolution, without other associated symptoms, denying diabetes, systemic arterial hypertension, alcohol consumption or smoking. Upon admission, physical examination revealed a Glasgow Coma Scale 15, isochoric and photoreactive pupils, no signs of meningeal irritation, grade 5 muscle strength in the upper limbs and grade 0 in the lower limbs according to MRC, areflexia in the lower limbs and decrease of superficial and deep sensitivity on them. Initially, the patient was admitted to the Intensive Care Unit (ICU), staying for 11 days for investigation for Guillain-Barré Syndrome (GBS) and for pulse therapy with methylprednizolone 1000mg IV for 5 days, but without improvement of symptoms. He was later transferred to our teaching hospital, where a new neurological assessment was performed, identifying persistence of the previous findings, in addition to the presence of horizontal choreic movements of the head, intention tremor in the upper limbs, significant dysmetria, worse on the left, nystagmus and without alteration of cranial nerves. During hospitalization, two biochemical evaluations of CSF were performed, but with unspecific results. The patient evolved with complications of cutaneous, urinary and pulmonary infections and died of sepsis after 110 days of hospitalization.
Discussion: Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory disease of autoimmune etiology that may have a presentation similar to GBS. In the current context, there are already a few reports that point to cases similar to the one we present, showing a possible correlation between the vaccine for COVID-19 and ADEM. Final Comments: In this case, we present a possible and rare correlation between the Astrazeneca vaccine for COVID-19 and ADEM. That said, the present report seeks to encourage more discussions about the possible complications of vaccination without, however, questioning its safety, since adverse effects are extremely rare.

Palavras Chave

ADEM; COVID-19; Vaccine;