Abstract
Bickerstaff brainstem encephalitis (BBE) is a rare, immune-mediated disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance. It has a complex multifactorial etiology, and a preceding infectious illness is seen in the majority of cases. Immune-mediated neurological syndromes following COVID-19 vaccination have been increasingly described. Here we report the case of a child developing BBE 2 weeks after COVID-19 vaccination. Despite nerve conduction studies and CSF analysis showing normal results, BBE was diagnosed on clinical ground and immunotherapy was started early with a complete recovery. Later, diagnosis was confirmed by positive anti-GQ1b IgG in serum. Even if there was a close temporal relationship between disease onset and COVID-19 vaccination, our patient also had evidence of a recent Mycoplasma pneumoniae infection that is associated with BBE. Indeed, the similarity between bacterial glycolipids and human myelin glycolipids, including gangliosides, could lead to an aberrantly immune activation against self-antigens (i.e., molecular mimicry). We considered the recent Mycoplasma pneumoniae infection a more plausible explanation of the disease onset. Our case report suggests that suspect cases of side effects related to COVID-19 vaccines need a careful evaluation in order to rule out well-known associated factors before claiming for a causal relationship.
Keywords: Bickerstaff brainstem encephalitis; COVID-19 vaccination; Mycoplasma pneumoniae; anti-GQ1b antibody; immune-mediated diseases.
【저자키워드】 COVID-19 vaccination, Mycoplasma pneumoniae, Bickerstaff brainstem encephalitis, immune-mediated diseases., anti-GQ1b antibody, 【초록키워드】 COVID-19, IgG, COVID-19 vaccine, Immunotherapy, Infection, Diagnosis, Encephalitis, Case report, serum, immune activation, Patient, Mycoplasma, molecular, etiology, Bacterial, Evidence, neurological, similarity, disease onset, Ataxia, complete recovery, Factor, Side effect, complex, syndrome, positive, immune-mediated diseases, multifactorial, immune-mediated disease, CSF analysis, described, diagnosed, the disease, characterized, majority, increasingly, external ophthalmoplegia, self-antigen, 【제목키워드】 pediatric, Encephalitis,