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Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: Onset Following Acute COVID-19 Infection, a Case
Mirla Avila1, Yuanyuan Tan2, Roberto Hernandez2
1Texas Tech University Health Sciences Center, Lubbock, TX, USA. mirla.avila@ttuhsc.edu.
Background And Objectives:
Acute COVID-19 infection has been associated with neurological involvement. We report a case series of newly diagnosed patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) developed in a short period of time after acute COVID-19 infection.
Methods:
New MS patients developing initial symptoms shortly after an acute COVID-19 infection were diagnosed based on the 2017 McDonald Criteria [Garcia-Ramos et al. in Cells, 2021]. The patients diagnosed with NMOSD met the 2015 International Panel criteria for the diagnosis of NMOSD (IPDN) [Thompson et al. in Lancet Neurol 17:162-173, 2018].
Results From The Ms Patient Group:
Ten patients were included who had developed initial MS symptoms after COVID-19 infection. Gender distribution was equal (50% male). The mean age was 28 (range 17-39) years. Average time to neurological presentation was between 2 and 6 weeks following acute COVID-19 infection. Partial transverse myelitis was the initial presentation in 40% of the cases, and 60% of patients had spinal cord lesions present at the moment of diagnosis. All patients showed enhancing lesions on brain magnetic resonance imaging (MRI). The presence of cerebrospinal fluid (CSF) oligoclonal bands was found in all six tested cases. The majority of patients (80%) were unvaccinated for COVID-19. The two vaccinated patients had received two doses of the monovalent COVID-19 messenger ribonucleic acid (mRNA) (Pfizer Biotech) vaccine and no booster, a year prior to contracting COVID-19.
Results From The Nmosd Group:
Two patients with NMOSD were included. Positive aquoporin-4 protein antibody (AQP-4 Ab) was detected in serum in both cases [one Enzyme Linked immunosorbent assay (ELISA) and one cell based]. Both patients had mild COVID-19 infection prior to presentation, initial neurologic symptoms presented between 3 and 6 weeks after COVID-19 infection. Neither patients were vaccinated. Both responded partially to steroids, one developed a relapse 40 days after diagnosis.
Conclusion:
COVID-19 infection has been linked to several neurological and immune-driven conditions. This study suggests that in susceptible individuals, acute COVID-19 infection may act as a trigger for developing MS and NMOSD.
Insights
Acute COVID-19 infection may trigger multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) in susceptible individuals. This case series highlights new diagnoses of these neurological conditions following SARS-CoV-2 infection.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Neurological involvement is a known complication of acute COVID-19.
- This study investigates a potential link between COVID-19 and the onset of new-onset demyelinating diseases.
Purpose of the Study:
- To report a case series of patients newly diagnosed with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) shortly after acute COVID-19 infection.
- To explore the temporal relationship between COVID-19 and the development of these immune-mediated neurological conditions.
Main Methods:
- Diagnosed new MS cases using the 2017 McDonald Criteria following COVID-19 infection.
- Diagnosed NMOSD cases using the 2015 International Panel criteria after COVID-19 infection.
- Collected clinical data, MRI findings, and cerebrospinal fluid (CSF) analysis.
Main Results:
- Ten MS patients (mean age 28, 50% male) presented 2-6 weeks post-COVID-19, with transverse myelitis and spinal cord lesions common.
- All MS patients showed enhancing brain lesions on MRI; CSF oligoclonal bands were present in tested cases.
- Two NMOSD patients (AQP-4 Ab positive) presented 3-6 weeks post-COVID-19, with partial response to steroids and one relapse.
Conclusions:
- COVID-19 infection is associated with various neurological and immune-driven conditions.
- Acute COVID-19 may act as a trigger for MS and NMOSD in susceptible individuals.
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