Acute encephalitis, myoclonus and Sweet syndrome after mRNA-1273 vaccine
Gabriel Torrealba-Acosta1, Jennifer C Martin2, Yve Huttenbach3
1Neurology, Baylor College of Medicine, Houston, Texas, USA gabriel.torrealbaacosta@bcm.edu.
Abstract:
A patient presented with fever, generalised rash, confusion, orofacial movements and myoclonus after receiving the first dose of mRNA-1273 vaccine from Moderna. MRI was unremarkable while cerebrospinal fluid showed leucocytosis with lymphocyte predominance and hyperproteinorrachia. The skin evidenced red, non-scaly, oedematous papules coalescing into plaques with scattered non-follicular pustules. Skin biopsy was consistent with a neutrophilic dermatosis. The patient fulfilled the criteria for Sweet syndrome. A thorough evaluation ruled out alternative infectious, autoimmune or malignant aetiologies, and all manifestations resolved with glucocorticoids. While we cannot prove causality, there was a temporal correlation between the vaccination and the clinical findings.
Insights
A patient developed neurological and skin symptoms, including confusion and rash, after the Moderna mRNA-1273 vaccine. These symptoms, consistent with Sweet syndrome, resolved with glucocorticoids, suggesting a possible vaccine-related reaction.
Area of Science:
- Neurology
- Dermatology
- Immunology
Background:
- The mRNA-1273 vaccine (Moderna) is a novel COVID-19 vaccine.
- Adverse events following vaccination are closely monitored.
- Sweet syndrome is an uncommon neutrophilic dermatosis.
Observation:
- A patient presented with fever, generalized rash, confusion, orofacial movements, and myoclonus post-Moderna mRNA-1273 vaccination.
- Cerebrospinal fluid analysis revealed leucocytosis with lymphocyte predominance and hyperproteinorrachia.
- Skin biopsy indicated neutrophilic dermatosis, meeting criteria for Sweet syndrome.
Findings:
- Neurological and dermatological manifestations occurred temporally after mRNA-1273 vaccination.
- Cerebrospinal fluid findings suggested an inflammatory neurological process.
- Skin lesions were characteristic of Sweet syndrome, a neutrophilic dermatosis.
Implications:
- This case highlights a potential, albeit rare, association between mRNA-1273 vaccination and Sweet syndrome.
- Prompt diagnosis and treatment with glucocorticoids led to complete resolution of symptoms.
- Further research is warranted to understand the potential immunologic mechanisms linking mRNA vaccines and Sweet syndrome.
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