Abstract General Information
First Multiple Sclerosis Attack After AstraZeneca COVID-19 Vaccine
Case Presentation: Multiple sclerosis (MS) is a chronic inflammatory autoimmune demyelinating disease of the central nervous system (CNS). There is evidence of a possible association between the ChAdOx1 adenovirus vector vaccine (Fiocruz/AstraZeneca) and new cases of demyelinating diseases of the CNS. We report the case of a 20-year-old male patient with type 1 diabetes mellitus who developed neurological symptoms one month after receiving the second dose of the AstraZeneca COVID-19 vaccine. He exhibited ataxic gait, hypotonia in the right upper limb, hypopallesthesia in the upper limbs, and urinary hesitation (EDSS 4), with no treatment. Brain MRI showed juxtacortical and periventricular, supra and infratentorial lesions, and gadolinium-uptake hypersignal in the cervical spinal cord. The cerebrospinal fluid showed 2 cells/mm³, 100% mononuclear, oligoclonal band type 2, and normal cytology. After 5 months, he was reassessed without improvements, and was prescribed glatiramer. Two months after the medication, he developed appendicular and gait ataxia, facial paresis and urinary hesitation (EDSS 6), without improvement after pulse therapy, and with increased lesions in the brain and confluent lesions in the thoracic spine. He was diagnosed with relapsing-remitting MS and started natalizumab (NTZ). Eleven months after the initial attack, he had no new attacks or MRI lesions at his latest follow-up, three months after treatment with NTZ.
Discussion: The association between the AstraZeneca COVID-19 vaccine and the development of MS is still being investigated. The patient presented with clinical and radiological characteristics consistent with MS after receiving the vaccine. However, this is a single case report, and further studies are needed to establish a causal relationship between the vaccine and the development of MS.
Final Comments: This case suggests that MS can be triggered by anti-COVID-19 vaccination. Clinicians should be aware of the possibility of vaccine-related demyelinating events and report any suspected cases to regulatory authorities.
Emerson Costa Oliveira, Felipe Baptista Brunheroto, Ana Cristina Cotta Queiroz, Beatriz Silva Lombardi , Clara Catharino Pinhati, Cleison Sanches Silva, Gabriel Coelho, Denison Pedrosa, Grazielle Fialho de Souza, Hugo Brito, Juliana Santiago Amaral, Juliana Monçao, Larissa Ferrarez, Márcia Prates, Natália Cirino Talim, Paulo Pereira Christo, Pedro L. B. dos Reis, Thales Ponsá, Marco Aurélio Lana-Peixoto