Fatal Acute Hemorrhagic Encephalomyelitis and Antiphospholipid Antibodies following SARS-CoV-2 Vaccination: A Case Report.
Annika KitsMattia Russel PantaloneChristopher IlliesAleksandra AntovicAnne-Marie LandtblomEllen IacobaeusPublished in: Vaccines (2022)
Acute hemorrhagic encephalomyelitis (AHEM) is a rare hyperacute form of acute disseminated encephalomyelitis (ADEM). The disease is characterized by fulminant inflammation and demyelination in the brain and spinal cord and is often preceded by an infection or vaccination. This case report presents a 53-year-old male with rheumatoid arthritis and ongoing treatment with methotrexate and etanercept who developed fatal AHEM following the second dose of the COVID-19 vaccine. The disease course was complicated by multiorgan thromboembolic disease and the presence of high/moderate levels of cardiolipin IgG antibodies and anti-beta-2 glycoprotein 1 IgG antibodies suggesting a possible antiphospholipid syndrome. Treatment with immunosuppressive therapies failed to improve the course. The report comprises comprehensive clinical, neuroimaging, and neuropathological findings. The case highlights diagnostic challenges in a patient with several preceding risk factors, including autoimmune disease, immunotherapy, and vaccination, with possible pathophysiological implications. The temporal association with the COVID-19 vaccination may suggest possible causality although evidence cannot be ascertained. Reporting possible adverse events following COVID-19 vaccination is important to identify at-risk populations and to accomplish control of the current pandemic.
Keyphrases
- sars cov
- coronavirus disease
- liver failure
- rheumatoid arthritis
- case report
- spinal cord
- risk factors
- respiratory syndrome coronavirus
- respiratory failure
- drug induced
- emergency department
- multiple sclerosis
- hepatitis b virus
- high dose
- white matter
- high intensity
- low dose
- systemic sclerosis
- subarachnoid hemorrhage
- smoking cessation
- replacement therapy
- extracorporeal membrane oxygenation
- electronic health record