Acute disseminated encephalomyelitis after COVID-19 vaccination: A case report

ABSTRACT

Objective: To report a case of a patient who developed acute disseminated encephalomyelitis in the setting of recent COVID-19 vaccination. Background: NA Design/Methods: Data was obtained through the medical records system of Westchester Medical Center in Valhalla, New York. Results: We report on a 53-year-old female patient with a past medical history of obstructive sleep apnea who presented in the emergency room (ER) with left-sided numbness and weakness, ataxia, vertigo, and slurred speech in the context of a three month long history of headaches that started one day after she received her first dose of COVID-19 vaccine. Brain imaging studies showed findings most suggestive of acute disseminated encephalomyelitis (ADEM). Initial pretreatment cerebrospinal fluid (CSF) analysis showed markedly elevated protein with normal glucose level. Extensive workup was negative for infectious, oncologic, autoimmune, and psychiatric etiologies. Over the course of hospitalization, the patient was found to have isolated elevated liver function tests (LFTs) with transaminitis and hepatomegaly on ultrasound. The initial treatment of a five-day methylprednisolone course did not result in significant clinical improvement. The patient was then started on plasma exchange therapy (PLEX) and successfully recovered by the end of the last session. Conclusions: Our case report exemplifies a rare but severe neurologic condition observed in the setting of recent COVID-19 vaccination in a previously healthy woman.