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Título

Post COVID-19 vaccination neuromyelitis optica spectrum disorder: Case report

RESUMO

Case
A 40 years old woman presented to the emergency service with left-sided hemiparesis and bilateral numbness in arms and legs progressive over four days. The patient didn’t have history of recent infection diseases, she received the first dose of CORONAVAC vaccine 12 days before the beginning of symptoms. Previously, this patient had been diagnosed with Neuromyelitis Optica Spectrum Disorders (NMOSD) after episodes of unilateral optic neuritis, in 2012, and a longitudinal extensive transverse myelitis, in 2013. At that time, she had a negative anti-aquaporin-4 (anti-AQP4). Since the last attack she had been using Azathioprine for recurrence prevention.
In the current hospitalization, MRI showed a diffuse thinning of the right optic pathway and, in cervical spinal cord, longitudinally extensive was identified at levels from C1 to C5, associated with an area of contrast enhancement at C3 and C4, suggestive of an active inflammatory/demyelinating lesion. A new longitudinally extensive cervical myelitis was then confirmed. Treatment was performed with methylprednisolone and plasmapheresis. The patient was discharged from hospital in good general condition. In a recent outpatient visit, the patient had complete remission of this deficits. In this consultation, azathioprine was replaced by rituximab due to therapeutic failure.
This case report highlights the temporal relationship between the realization of the vaccine for SARS-Cov2 and an outbreak of NMOSD, aiming at the discussion of possible causality between the vaccine and the occurrence of relapses in patients with autoimmune diseases.
SARS-CoV-2 infection has been associated with the development of autoimmune processes. Molecular mimicry has been suggested as a potential mechanism for these associations. Some studies showed that antibodies against the spike protein S1 of SARS-CoV-2 had high affinity against specific human tissue proteins. As this is the same viral protein that the vaccine mRNA codes for, it is plausible that these vaccines may unmask or flare-up autoimmune diseases in predisposed patients.
Whether there exists a causal relationship between COVID-19 vaccination and the flare-up of autoimmune diseases it remains to be determined. Only long-term follow-up of large cohorts of patients receiving the vaccine will answer this question. Until then, healthcare providers are encouraged to remain vigilant about potential side effects that will likely emerge with the spreading of vaccination.

Palavras Chave

Coronavac; NMOSD; Covid19