Abstract
Background: In around 20% of cases, myelin oligodendrocyte glycoprotein (MOG) immunoglobulin (IgG)-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) first occurs in a postinfectious or postvaccinal setting.
Objective: To report a case of MOG-EM with onset after vaccination with the Pfizer BioNTech COVID-19 mRNA vaccine BNT162b2 (Comirnaty®) and to provide a comprehensive review of the epidemiological, clinical, radiological, electrophysiological and laboratory features as well as treatment outcomes of all published patients with SARS-CoV-2 vaccination-associated new-onset MOG-EM.
Methods: Case report and review of the literature.
Results: In our patient, MOG-IgG-positive (serum 1:1000, mainly IgG1 and IgG2; CSF 1:2; MOG-specific antibody index < 4) unilateral optic neuritis (ON) occurred 10 days after booster vaccination with BNT162b2, which had been preceded by two immunizations with the vector-based Oxford AstraZeneca vaccine ChAdOx1-S/ChAdOx1-nCoV-19 (AZD1222). High-dose steroid treatment with oral tapering resulted in complete recovery. Overall, 20 cases of SARS-CoV2 vaccination-associated MOG-EM were analysed (median age at onset 43.5 years, range 28-68; female to male ratio = 1:1.2). All cases occurred in adults and almost all after immunization with ChAdOx1-S/ChAdOx1 nCoV-19 (median interval 13 days, range 7-32), mostly after the first dose. In 70% of patients, more than one CNS region (spinal cord, brainstem, supratentorial brain, optic nerve) was affected at onset, in contrast to a much lower rate in conventional MOG-EM in adults, in which isolated ON is predominant at onset and ADEM-like phenotypes are rare. The cerebrospinal fluid white cell count (WCC) exceeded 100 cells/μl in 5/14 (36%) patients with available data (median peak WCC 58 cells/μl in those with pleocytosis; range 6-720). Severe disease with tetraparesis, paraplegia, functional blindness, brainstem involvement and/or bladder/bowel dysfunction and a high lesion load was common, and treatment escalation with plasma exchange (N = 9) and/or prolonged IVMP therapy was required in 50% of cases. Complete or partial recovery was achieved in the majority of patients, but residual symptoms were significant in some. MOG-IgG remained detectable in 7/7 cases after 3 or 6 months.
Conclusions: MOG-EM with postvaccinal onset was mostly observed after vaccination with ChAdOx1-S/ChAdOx1 nCoV-19. Attack severity was often high at onset. Escalation of immunotherapy was frequently required. MOG-IgG persisted in the long term.
Keywords: AZD1222; BNT162b2; Brainstem encephalitis; ChAdOx1 nCoV-19; ChAdOx1-S; Coronavirus disease 2019 (COVID-2019); Encephalitis; Longitudinally extensive transverse myelitis (LETM); MOG antibodies (MOG-IgG); Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD); Myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM); Myelitis; Neuromyelitis optica spectrum disorders; Optic neuritis; Postvaccinal; Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2); Vaccination; mRNA-1273.
【저자키워드】 vaccination, Encephalitis, BNT162b2, AZD1222, Myelitis, Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), ChAdOx1 nCoV-19, mRNA-1273., ChAdOx1-S, Optic neuritis, Neuromyelitis optica spectrum disorders, Postvaccinal, Myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM), Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), MOG antibodies (MOG-IgG), Longitudinally extensive transverse myelitis (LETM), Coronavirus disease 2019 (COVID-2019), Brainstem encephalitis, 【초록키워드】 COVID-19, Treatment, Coronavirus disease 2019, Vaccine, coronavirus, Treatment outcome, SARS-CoV2, therapy, antibody, mRNA vaccine, mRNA-1273, Immunotherapy, severity, immunization, Brain, Pfizer, Neuromyelitis Optica, serum, Adults, Immunoglobulin, male, female, Patient, phenotype, plasma, epidemiological, glycoprotein, Brainstem, cerebrospinal fluid, disease, CNS, ChAdOx1, patients, AstraZeneca, IgG1, booster vaccination, CSF, MOG, Escalation, Postinfectious, white cell, complete recovery, dysfunction, acute respiratory syndrome, available data, blindness, Oxford, first dose, median age, median interval, attack, radiological, steroid treatment, affected, occurred, remained, detectable, required, analysed, median, functional, majority, occur, predominant, exceeded, much lower, laboratory feature, Myelin, Optic, paraplegia, patients with SARS-CoV-2, residual symptom, WCC, 【제목키워드】 coronavirus, Case report, MOG, acute respiratory syndrome,