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Título

Acute Disseminate Encephalomyelitis after Pfizer Vaccine: case report

RESUMO

CASE PRESENTATION: A 44-year-old male patient from Manaus, Amazonas was admitted in our hospital with a history of upper limbs paraparesis starting on April 21, 10 days after Pfizer COVID vaccine (it was his 3rd dose; the 1st and 2nd doses were Coronavac), which progressively affected his lower limbs associated with stiff neck, nausea and vomiting. He evolved with dysphagia, dysarthria, urinary retention and severe tetraparesis, looking for an emergency service on may 15, where he performed a cranial CT which showed right frontal hypodensity and enlargement of the right temporal horn of the lateral ventricle, being later referred to the neurology Intensive Care service for better investigation. CSF collection did not show infectious processes. Neurological examination revealed grade 2 strength tetraparesis in the proximal lower limbs and plegia distally, while the upper limbs had 1- strength proximally and 1+ distally. Spastic tetraparesis associated with clonus in superior and lower limbs was also found. Reduced protopathic touch globally. Also bilateral vertical nystagmus and paresthesia in the left hemiface, without other alterations. In view of the imaging findings in association with clinical manifestations, the diagnosis of Acute Disseminated Encephalomyelitis (ADEM) was confirmed. After the condition worsened, due to dyspnea and hypoxemic respiratory insufficiency , the patient was referred to the ICU where he underwent endotracheal intubation and, to date, 7 plasmapheresis sessions. Now, he is in a lethargic state, with sepsis due to urinary tract infection.
DISCUSSION: ADEM is a rare disease that can be associated with other neurological diseases, such as Guillain-Barré syndrome or isolated encephalitis. It is a diagnosis of exclusion and, therefore, imaging tests and CSF collection are essential. In the clinical aspects, several signs of encephalopathy can be found, such as headache, ataxias, hemiparesis and cranial nerve alterations. Treatment revolves around immunosuppression, typically with human immunoglobulin, steroids, and, in severe cases, plasmapheresis.
FINAL CONSIDERATIONS: The case presented shows a rare case of ADEM after the 3rd dose of the vaccine against COVID-19. The present report does not aim to question the safety of vaccines, since adverse effects of this severity are rare, but rather to share this specific case and, in this way, foster discussions about the preparation of health professionals to deal with such a situation.

Palavras Chave

Acute disseminated encephalomyelitis, Vaccine, COVID-19

Área

Neuroimunologia