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Potential autoimmune encephalitis following yellow fever vaccination: A report of three cases

Bruno Fukelmann Guedes1, Ana Freitas Ribeiro2, Lecio Figueira Pinto1

  • 1Departmento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Journal of Neuroimmunology
|March 29, 2021
PubMed

Insights

Yellow fever vaccination can rarely cause autoimmune encephalitis, a neuroinflammatory condition. Autoimmune encephalitis, particularly anti-N-methyl-D-aspartate receptor encephalitis, should be considered in neurologic adverse events post-vaccination.

Area of Science:

  • Neurology
  • Immunology
  • Vaccinology

Background:

  • Meningoencephalitis after yellow fever vaccination is typically viewed as a viral neuroinvasive disease.
  • Yellow fever vaccination is crucial for preventing yellow fever virus infection.

Observation:

  • Three patients developed autoimmune encephalitis syndromes within 1-27 days post-yellow fever vaccination.
  • Two patients had anti-N-methyl-D-aspartate receptor antibodies; one had anti-neurexin-3 antibodies.
  • One case showed vaccine-associated neurotropic disease with yellow fever IgM, suggesting an infectious-autoimmune overlap.

Findings:

  • Autoimmune encephalitis, including anti-N-methyl-D-aspartate receptor encephalitis, can be triggered by yellow fever vaccination.
  • The presence of specific antibodies (anti-NMDAR, anti-neurexin-3) indicates an autoimmune mechanism.
  • An infectious-autoimmune overlap is possible in vaccine-associated neurotropic disease.

Implications:

  • Autoimmune encephalitis must be included in the differential diagnosis for neurologic complications following yellow fever vaccination.
  • This finding broadens the understanding of potential adverse events associated with yellow fever vaccines.
  • Further research is needed to elucidate the precise mechanisms linking vaccination to autoimmune encephalitis.
Keywords:
Autoimmune diseasesEncephalitisLupusNMDA-r encephalitisYellow fever vaccine

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