Fatal Multiple Sclerosis After COVID-19 Vaccination and Infection

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system, leading to a wide range of neurological symptoms. 
While this disease is most commonly diagnosed in individuals in their 20s and 30s, it is rare for MS to result in sudden death in younger patients. 

A 19-year-old male soldier received the second dose of the COVID-19 vaccine (Pfizer-BioNTech). 3 months later, he started experiencing epileptic seizures during sleep and was admitted to an outside hospital. Since the first seizure, he presented with 5 more generalized tonic-clonic seizures within a week. He had no other symptoms or signs of meningeal irritation. Cerebrospinal fluid (CSF) analysis including culture and viral polymerase chain reaction revealed no abnormalities except for mild pleocytosis. Oligoclonal band and aquaporin-4 antibodies were not detected in the CSF and serum. Brain MRI performed 1 day after the seizure revealed T2 hyperintensities in the periventricular region, subcortical white matter, and left basal ganglia, raising a suspicion of demyelinating disorder, and leptomeningeal enhancement of cerebral convexities. Additional brain MRI performed 8 days after the first seizure was suggestive of cerebral venous thrombosis (CVT) due to intracranial hypotension. 

He was treated with empirical antiviral/antibiotic medications, anticonvulsant and anticoagulant for 3 weeks and was discharged after symptom improvement. Seizures seemed to be controlled with medication management. Two months later he developed a sore throat without fever and tested positive for COVID-19. 10 days later, he returned to duty. He had been suffering from left finger numbness at night and because of this asked his commander for exemption from night duty. A little over a week since returning to work, said to his colleague “I cannot sleep well these days and I feel like I'm having a seizure at night.” Next morning, he was found dead in bed in supine position, with his head slightly turned to the right and his right arm raised. 

Based on autopsy, histologic, and toxicological findings and medical records, the cause of death was determined to be MS with suspected exacerbation. 



REFERENCE

Jeon YH, Choi S, Park JH, Lee JK, Yeo NS, Lee S, Suh YL. Sudden Death Associated With Possible Flare-Ups of Multiple Sclerosis After COVID-19 Vaccination and Infection: A Case Report and Literature Review. J Korean Med Sci. 2023 Mar 13;38(10):e78. doi: 10.3346/jkms.2023.38.e78. PMID: 36918031; PMCID: PMC10010908.

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