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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Acute hemorrhagic encephalomyelitis (AHEM) is a rare hyperacute form of acute disseminated encephalomyelitis (ADEM). The disease is characterized by fulminant inflammation and demyelination in the brain and spinal cord and is often preceded by an infection or vaccination. This case report presents a 53-year-old male with rheumatoid arthritis and ongoing treatment with methotrexate and etanercept who developed fatal AHEM following the second dose of the COVID-19 vaccine. The disease course was complicated by multiorgan thromboembolic disease and the presence of high/moderate levels of cardiolipin IgG antibodies and anti-beta-2 glycoprotein 1 IgG antibodies suggesting a possible antiphospholipid syndrome. Treatment with immunosuppressive therapies failed to improve the course. The report comprises comprehensive clinical, neuroimaging, and neuropathological findings. The case highlights diagnostic challenges in a patient with several preceding risk factors, including autoimmune disease, immunotherapy, and vaccination, with possible pathophysiological implications. The temporal association with the COVID-19 vaccination may suggest possible causality although evidence cannot be ascertained. Reporting possible adverse events following COVID-19 vaccination is important to identify at-risk populations and to accomplish control of the current pandemic.

Details

Title
Fatal Acute Hemorrhagic Encephalomyelitis and Antiphospholipid Antibodies following SARS-CoV-2 Vaccination: A Case Report
Author
Kits, Annika 1 ; Mattia Russel Pantalone 2   VIAFID ORCID Logo  ; Illies, Christopher 3 ; Antovic, Aleksandra 4   VIAFID ORCID Logo  ; Landtblom, Anne-Marie 5 ; Iacobaeus, Ellen 2 

 Department of Neuroradiology, Karolinska University Hospital, 171 76 Stockholm, Sweden 
 Department of Clinical Neuroscience, Division of Neurology, Karolinska Institute and Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden 
 Karolinska University Laboratory, Department of Clinical Pathology and Cancerdiagnostics, Karolinska University Hospital, 171 76 Stockholm, Sweden 
 Department of Medicine, Division of Rheumatology, Karolinska Institute and Rheumatology, Karolinska University Hospital, 171 76 Stockholm, Sweden 
 Department of Medical Sciences, Division of Neurology, Uppsala University, 751 85 Uppsala, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linkoping, Sweden 
First page
2046
Publication year
2022
Publication date
2022
Publisher
MDPI AG
e-ISSN
2076393X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2756812581
Copyright
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.