Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series
IntroductionmRNA coronavirus disease 2019 (COVID-19) vaccination has been widely used to arrest the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Rarely, autoimmune events such as relapses in patients with multiple sclerosis (MS) have been reported after vaccin...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.897275/full |
| _version_ | 1818010929664622592 |
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| author | Carlos Quintanilla-Bordás Francisco Gascón-Gimenez Carmen Alcalá María Payá Javier Mallada Raquel Silla Sara Carratalà-Boscà Raquel Gasque-Rubio Jessica Castillo Bonaventura Casanova |
| author_facet | Carlos Quintanilla-Bordás Francisco Gascón-Gimenez Carmen Alcalá María Payá Javier Mallada Raquel Silla Sara Carratalà-Boscà Raquel Gasque-Rubio Jessica Castillo Bonaventura Casanova |
| author_sort | Carlos Quintanilla-Bordás |
| collection | DOAJ |
| description | IntroductionmRNA coronavirus disease 2019 (COVID-19) vaccination has been widely used to arrest the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Rarely, autoimmune events such as relapses in patients with multiple sclerosis (MS) have been reported after vaccination. However, the possible effects of vaccination in a patient already experiencing the symptoms of a relapse represent an unusual scenario that has not been described.Patients and MethodsThis is a retrospective case series of four patients from three major tertiary referral centers that received mRNA COVID-19 vaccination after starting with symptoms of acute demyelination of the central nervous system due to non-recognized MS. A detailed description of each case, including MRI studies, serum light-neurofilament levels, and cerebrospinal fluid (CSF) cytokine profile, is provided.Case DescriptionAll patients presented exacerbation of ongoing symptoms after vaccination (range 14–112 days first dose). All patients presented MRI features suggestive of highly active MS and fulfilled McDonald 2017 criteria at the time of presentation. All patients presented high serum light-neurofilament levels and oligoclonal G bands restricted to the CSF. Higher levels of interleukin-6 in the CSF were present in the more severe cases.DiscussionWe describe exacerbation of relapses after mRNA COVID-19 vaccination. We hypothesize RNA sensors such as Toll-like receptor 7 may be activated and contribute to amplify the inflammatory response during a relapse.ConclusionPatients should seek medical attention if experiencing acute neurological symptoms, especially before vaccination. Fast diagnostic procedures and prompt treatment should be performed in these patients. Pharmacovigilance and further study are warranted to confirm causality. |
| first_indexed | 2024-04-14T06:01:47Z |
| format | Article |
| id | doaj.art-88844609842a4dbd8a15baee29893f00 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-14T06:01:47Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-88844609842a4dbd8a15baee29893f002022-12-22T02:08:44ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-04-011310.3389/fneur.2022.897275897275Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case SeriesCarlos Quintanilla-Bordás0Francisco Gascón-Gimenez1Carmen Alcalá2María Payá3Javier Mallada4Raquel Silla5Sara Carratalà-Boscà6Raquel Gasque-Rubio7Jessica Castillo8Bonaventura Casanova9Neuroimmunology Unit, Polytechnic and University Hospital La Fe of València, Valencia, SpainNeuroimmunology Unit, Clinic University Hospital of València, Valencia, SpainNeuroimmunology Unit, Polytechnic and University Hospital La Fe of València, Valencia, SpainNeurology Service, Polytechnic and University Hospital La Fe of València, Valencia, SpainNeurology Service, University General Hospital of Elda, Elda, SpainNeuroimmunology Unit, Clinic University Hospital of València, Valencia, SpainNeuroimmunology Unit, Polytechnic and University Hospital La Fe of València, Valencia, SpainNeuroimmunology Unit, Polytechnic and University Hospital La Fe of València, Valencia, SpainNeuroimmunology Unit, Polytechnic and University Hospital La Fe of València, Valencia, SpainNeuroimmunology Unit, Polytechnic and University Hospital La Fe of València, Valencia, SpainIntroductionmRNA coronavirus disease 2019 (COVID-19) vaccination has been widely used to arrest the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Rarely, autoimmune events such as relapses in patients with multiple sclerosis (MS) have been reported after vaccination. However, the possible effects of vaccination in a patient already experiencing the symptoms of a relapse represent an unusual scenario that has not been described.Patients and MethodsThis is a retrospective case series of four patients from three major tertiary referral centers that received mRNA COVID-19 vaccination after starting with symptoms of acute demyelination of the central nervous system due to non-recognized MS. A detailed description of each case, including MRI studies, serum light-neurofilament levels, and cerebrospinal fluid (CSF) cytokine profile, is provided.Case DescriptionAll patients presented exacerbation of ongoing symptoms after vaccination (range 14–112 days first dose). All patients presented MRI features suggestive of highly active MS and fulfilled McDonald 2017 criteria at the time of presentation. All patients presented high serum light-neurofilament levels and oligoclonal G bands restricted to the CSF. Higher levels of interleukin-6 in the CSF were present in the more severe cases.DiscussionWe describe exacerbation of relapses after mRNA COVID-19 vaccination. We hypothesize RNA sensors such as Toll-like receptor 7 may be activated and contribute to amplify the inflammatory response during a relapse.ConclusionPatients should seek medical attention if experiencing acute neurological symptoms, especially before vaccination. Fast diagnostic procedures and prompt treatment should be performed in these patients. Pharmacovigilance and further study are warranted to confirm causality.https://www.frontiersin.org/articles/10.3389/fneur.2022.897275/fullmRNA COVID-19 vaccinevaccinationmultiple sclerosisrelapsesexacerbation (symptom flare up) |
| spellingShingle | Carlos Quintanilla-Bordás Francisco Gascón-Gimenez Carmen Alcalá María Payá Javier Mallada Raquel Silla Sara Carratalà-Boscà Raquel Gasque-Rubio Jessica Castillo Bonaventura Casanova Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series Frontiers in Neurology mRNA COVID-19 vaccine vaccination multiple sclerosis relapses exacerbation (symptom flare up) |
| title | Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series |
| title_full | Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series |
| title_fullStr | Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series |
| title_full_unstemmed | Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series |
| title_short | Case Report: Exacerbation of Relapses Following mRNA COVID-19 Vaccination in Multiple Sclerosis: A Case Series |
| title_sort | case report exacerbation of relapses following mrna covid 19 vaccination in multiple sclerosis a case series |
| topic | mRNA COVID-19 vaccine vaccination multiple sclerosis relapses exacerbation (symptom flare up) |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.897275/full |
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