二价新冠肺炎加强疫苗和四价季节性流感疫苗后的横贯性脊髓炎

Q4 Immunology and Microbiology

Clinical and Experimental Neuroimmunology Pub Date : 2023-01-24 DOI:10.1111/cen3.12742

Teresa L. Xiao, Alexandre Zaharia, Anas S. Al-Smadi, Caleb J. Murphy

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引用次数: 0

摘要

一名78岁女性，既往有骨质疏松、二尖瓣反流和高脂血症病史，于2022年9月出现左下肢无力和麻木。在就诊前24小时，患者处于神经系统基线，正在活动，突然出现头晕和左大腿感觉异常，随后出现全身左腿无力。她去了急诊室，无法独立行走。她注意到左上腹部有疼痛的带状感觉，但否认鞍状麻醉或大便失禁。在左下肢体检中，髋关节和膝关节屈曲和伸展的力量为4/5，多个皮节对轻度触摸的感觉普遍下降，巴宾斯基征呈阳性。对右下肢的检查并不显著。实验室检查包括严重急性呼吸系统综合征冠状病毒2型聚合酶链式反应、C反应蛋白、肌酸激酶、促甲状腺激素、维生素B12、血管紧张素转换酶、抗核抗体、抗HMG-CoA还原酶抗体、抗SSA和SSB抗体以及抗双链DNA抗体均在正常范围内或阴性。没有造影剂的脑磁共振成像（MRI）并不显著。经对比的初步胸部MRI显示，在T5-6时出现T2高信号的非特异性、非增强性病变（见图1A、B）。医院第4天的重复胸部成像再次是非特异性的，鉴别诊断仍然很广泛。起初，患者的力量和功能每天都有适度的改善，但从医院第7天到第9天，她的功能改善停滞不前，出现了尿潴留和便秘。在住院期间，尿潴留逐渐改善，在住院第7天至第13天，记录的排尿后残余量（PVR）逐渐降低。第8天在医院进行腰椎穿刺。脑脊液研究在正常范围内或阴性，包括细胞计数（收集的第四管中为零核细胞）、革兰氏染色和培养、多病原体脑膜炎组（包括水痘-带状疱疹病毒和单纯疱疹病毒1和2）以及寡克隆带。在医院第9天，将血清样本送往外部实验室，用荧光激活细胞分选（FACS）测定法检测抗MOG和抗NMO/AQP4抗体。两次检测结果均为阴性。由于症状的进展和缺乏替代诊断，在医院第10天重复进行了胸部MRI对比检查。这显示出更明显的T2高信号，现在从T3延伸到T7，同时在T5–T6出现病理对比增强，与横贯性脊髓炎一致（TM；见图1D–F）。值得注意的是，对第三医院影像学的回顾性审查显示，轴向影像学有微弱、不明确的增强（见图1C）。她否认最近发生过任何传染事件、生病的接触者或咳嗽或流涕等常见传染症状。她没有已知的自身免疫性疾病家族史。然而，她在症状出现前6天接种了二价Pfizer-BioNTech新冠肺炎加强疫苗和Fluzone四价流感疫苗。患者被诊断为横贯性脊髓炎，并完成了5天的高剂量静脉注射甲基强的松龙，之后出院完成门诊物理治疗。出院后2个月，她被接收：2022年11月22日修订：2022年12月21日接受：2023年1月5日

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Transverse myelitis following bivalent COVID-19 booster vaccine and quadrivalent seasonal influenza vaccine

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Transverse myelitis following bivalent COVID-19 booster vaccine and quadrivalent seasonal influenza vaccine

We present a case of acute partial transverse myelitis (TM) that developed 6 d following covaccination with a bivalent COVID-19 booster vaccine and quadrivalent influenza vaccine. Although initial imaging of the thoracic spine was nonspecific, repeat magnetic resonance imaging (MRI) showed a T2 hyperintense lesion with contrast enhancement, consistent with TM. The risk of rare but catastrophic neurologic complications following the bivalent COVID-19 booster vaccine and/or covaccination with COVID-19 and influenza vaccines is the subject of ongoing investigation in the medical community.

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来源期刊

Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)

CiteScore

1.60

自引率

0.00%

发文量