Ipsilateral Radial Neuropathy after COVID-19 Vaccination in a 21-year-old man

Healthy 21-year-old male experienced mild pain/tenderness in the arm after receiving the first dose of BNT162b2 vaccine. It resolved in ~3 days.

Later he received the second dose of the same vaccine in the deltoid area of his left arm. He gradually noticed a severe burning sensation and weakness in that arm. Half a day later his hand began to hang down at the wrist ("wrist drop"). 

On neurological examination two days after vaccination, his wrist and finger drop on the left side were near paralysis (MRC grade 1-2 on the scale of 1-5 of muscle power).  In addition, there was weakness in arm extension and flexion (MRC grade 3-4/5). On sensory examination, there was dysesthesia and numbness over the lateral dorsum of the left hand. Reflexes were hypoactive. Left radial neuropathy with demyelination and axonal injury were suspected. Laboratory findings for vasculitis, autoimmune disorders, malignancy and infectious disease were unremarkable.

The patient was diagnosed with ipsilateral axillary lymphadenopathy (LAP) following COVID-19 vaccination. He was treated with intravenous high dose methylprednisolone with physiotherapy for 5 days followed by daily oral prednisolone for 1 month. 1.5 months later the patient's wrist drop recovered completely. 

REFERENCE

Lee SM, Hong JY, Kim SY, Na SJ. Ipsilateral Radial Neuropathy after COVID-19 mRNA Vaccination in an Immunocompetent Young Man. Yonsei Med J. 2022 Oct;63(10):966-970. doi: 10.3349/ymj.2022.0038. PMID: 36168250.

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