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Título

54-YEAR-OLD MALE DIAGNOSED WITH ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) AFTER RECEIVING A DOSE OF ASTRAZENECA COVID-19 VACCINE.

RESUMO

CASE PRESENTATION
54-YEAR-OLD MALE FARMER, FROM NORTHEAST BRAZIL, PREVIOUSLY HEALTHY, PRESENTED WITH HEADACHE AND NON-MEASURED FEVER 2 DAYS BEFORE NEUROLOGICAL SYMPTOMS. PATIENT RECEIVED A DOSE OF ASTRAZENECA VACCINE AGAINST SARS-COV-2, AND ON THE FOLLOWING DAY, HE PRESENTED WITH WORSENING OF HEADACHE AND LEFT-SIDED WEAKNESS. HOURS LATER, CONFUSION, ALTERED LEVEL OF CONSCIOUSNESS AND SEIZURES.
MAGNETIC RESONANCE IMAGING (MRI) REVEALED WHITE-MATTER T2/FLAIR HYPERINTENSE PLAQUES AND DIFFUSION WEIGHTED (DWI) ALTERATIONS ON RIGHT OCCIPITAL, TEMPORAL, FRONTAL AND PARIETAL LOBES, AS WELL AS BASAL GANGLIA. ON A SECOND MRI STUDY 3 DAYS LATER, LESIONS PROGRESSED IN SIZE AND NEW LESIONS WERE SEEN ON THE LEFT SIDE.
ELECTROENCEPHALOGRAM DISPLAYED FOCAL SLOWING ON BOTH RIGHT AND LEFT FRONTAL AND TEMPORAL LOBES, FOCAL EPILEPTIFORM DISCHARGES ON RIGHT FRONTAL LOBE AND DISRUPTION OF BASE ACTIVITY.
DURING THE NEXT DAYS, PATIENT DEVELOPED ACUTE KIDNEY INJURY. HE ALSO NEEDED VENTILATORY SUPPORT AND WAS TRANSFERRED TO AN INTENSIVE CARE UNIT.
HE WAS SUBMITTED TO THERAPY WITH ANTIBIOTICS FOR BACTERIAL MENINGITIS AND ACYCLOVIR, AS WELL AS METHYLPREDNISOLONE IN HIGH DOSES. A PROGRESSIVE IMPROVEMENT WAS SEEN ON LEVEL OF CONSCIOUSNESS. THERE WAS PARCIAL RECOVERY OF COGNITION AND MOTOR SYMPTOMS
PATIENT NO LONGER NEEDED RENAL REPLACEMENT THERAPY. HE CONTINUES TO RECEIVE ANTI-EPILEPSY MEDICATIONS WITH COMPLETE CONTROL OF SEIZURES.
AFTER TREATMENT, CEREBRAL SPINAL FLUID (CSF) ANALYSIS SHOWED CELL COUNT 1, PROTEIN 59.1 AND GLUCOSE 98. VIRAL AND BACTERIAL PANEL WAS NEGATIVE FOR ALL PATHOGENS ON ESSAY. PCR FOR SARS-COV-2 ON CSF CAME BACK NEGATIVE.
DISCUSSION
THIS PATIENT WAS DIAGNOSED WITH ADEM AFTER RECEIVING A DOSE OF ASTRAZENECA COVID-19 VACCINE. THIS CASE FIGURES AMONG RARE POSSIBLE SIDE EFFECTS OF A RECENTLY RELEASED VACCINE. HOWEVER, FURTHER OBSERVATION IS REQUIRED TO ESTABLISH CAUSALITY, SINCE THIS PATIENT REPORTED PRODROMIC SYMPTOMS EVEN BEFORE RECEIVING THE DOSE. OTHER DEMYELINATING CNS DISEASES, SUCH AS MULTIPLE SCLEROSIS, INFECTIOUS AETIOLOGIES, VASCULITIS, CEREBRAL VENOUS THROMBOSIS AND POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME SHOULD BE CONSIDERED IN THE DIFFERENTIAL DIAGNOSIS FOR THIS CASE.
FINAL CONSIDERATIONS
HOPEFULLY, THIS CASE REPORT WILL HELP SCIENTIFIC COMMUNITY IN FACE OF URGENT AND RECENT FINDINGS CONCERNING COVID-19 PANDEMICS.

Palavras Chave

vaccines, acute disseminated encephalomyelitis, COVID-19, neuroimmunology