Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: a Case Report

Area of Science:

• Neurology
• Immunology
• Vaccinology

Background:

• COVID-19 vaccination campaigns aim to reduce disease severity and transmission.
• While generally safe, post-vaccination adverse events, including demyelinating diseases, have been reported.
• Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare autoimmune condition affecting the central nervous system.

Observation:

• An 80-year-old male developed progressive leg weakness and numbness two days after his second Pfizer-BioNTech COVID-19 vaccine dose.
• Spinal MRI revealed longitudinally extensive transverse myelitis.
• Serum testing confirmed the presence of aquaporin-4 (AQP4) antibodies.

Findings:

• The patient was diagnosed with de novo aquaporin-4-positive NMOSD.
• Treatment included high-dose methylprednisolone, plasma exchange, and mycophenolate mofetil.
• The patient showed some improvement following treatment.

Implications:

• This case suggests a potential link between COVID-19 vaccination and the onset of NMOSD, even in the elderly.
• Consider AQP4 antibody testing for individuals presenting with post-vaccination myelitis.
• Further research and vaccine surveillance are crucial to understand NMOSD risks post-vaccination.