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Título

ACUTE AUTONOMIC NEUROPATHY POST COVID19 VACCINE: A CASE REPORT.

RESUMO

CASE PRESENTATION
A 26-years old woman presented with a four-days history of recurrent postprandial vomiting, diarrhea, headache and fainting. Her symptoms started within 24 hours after the second dose of COVID-19 vaccine AstraZeneca/Oxford.
Her symptoms were mild at presentation, including headache, lightheadedness and vomiting. Then she had a syncope while taking shower and started experiencing recurrent episodes of palpitation and dizziness.
On neurological examination her gait was normal. She was able to walk on heels and toes. Romberg sign was absent. Coordination was normal. There was an anisocoria and light-near reflex dissociation. Pinprick evoked pain, tactile and thermal sensation was abnormal throughout, but worse on the left side. Strength was normal in all muscles. Deep tendon reflexes were normal. There were no upper motor neuron signs. Her blood pressure lying was 100x60 mmHg and seated, 76x50mmHg. She did not tolerate standing.
Tilt test was performed and at the 3rd minute her heart rate was 180 bpm, she had near fainting symptons, causing it to be interrupted. CSF was normal at the 10th day of symptoms. Brain MRI was unremarkable. NCS performed at days 10 and 20 were within normal limits. Small-fibre evaluation revealed decreased RR variability. QST was abnormal. Sympathetic skin response to sound stimulus was absent in the upper limbs. Considering her clinical presentation and the electrophysiological abnormalities found, a diagnosis of acute autonomic neuropathy was made. She was treated with high dose of IV methylprednisolone and IgIV with excellent response. She was discharged after 2 weeks with mild tachycardia.
DISCUSSION
Acute autonomic neuropathy (AAN) is an extremely rare syndrome and may manifest with abnormalities in cardiovascular (orthostatic hypotension), gastrointestinal (anorexia or early satiety) and urogenital systems (erectile dysfunction), dry eyes and mouth, and also visual impairment due to disturbance of pupils constriction. AAN is often immune mediated. The vast majority of cases have good prognosis.
It is known mild abnormalities on autonomic system are common following COVID-19 infection. This is the second case report that associates COVID-19 vaccine and AAN.
FINAL COMMENTS
The case we present, describing the development of acute autonomic neuropathy after COVID-19 vaccination and favorable response possibly associated with IVIg and corticosteroids, supports previous reports of this association.

Palavras Chave

Neuropathy; Dysautonomia; Covid-19 Vaccines.