Vaccine-Induced Encephalitis

Encephalitis is an inflammatory condition affecting the brain, characterized by the swelling of the brain tissue. This inflammation is often triggered by viral infections, although it can also result from bacterial infections, autoimmune disorders, or vaccination. 

Multiple cases have been presented in the literature. 


Anti NMDA Autoimmune Encephalitis in a Pediatric Patient:

Anti-NMDA receptor encephalitis is a rare autoimmune disorder that affects the central nervous system. In this condition, the body's immune system mistakenly targets and attacks NMDA receptors in the brain. NMDA receptors are essential for normal brain function, and their dysfunction can lead to a range of neurological symptoms. The condition is often associated with the presence of antibodies against the NMDA receptors.

The case involves a 13-year-old female who developed anti-NMDA autoimmune encephalitis after receiving the Pfizer–BioNTech COVID-19 vaccine.

The patient presented with subacute neurological and psychiatric symptoms, confirming the diagnosis.

Recovery was achieved with intravenous immunoglobulins and steroids.


Acute Encephalitis in an 82-Year-Old Female:


The patient experienced acute encephalitis after the first dose of mRNA-1273 COVID-19 vaccine.

Symptoms included fever, headache, and behavior change, with EEG and MRI findings.

Figure on the right summarizes the timeline of clinical course and manifestations.

Response to steroid pulse therapy resulted in a full recovery, emphasizing the importance of timely treatment.

Post-COVID-19 Vaccine Acute Encephalitis in an Adult:

An adult patient developed encephalitis with hallucination and seizure one day after the second dose of the Sinopharm vaccine.

The case raises concerns about the short- and long-term safety profile of vaccines, requiring careful monitoring.


Postvaccinal Encephalitis after ChAdOx1 nCov-19:

A case series reports post-vaccinal encephalitis following ChAdOx1 nCov-19 vaccination.

Patients responded well to immunosuppressive therapy with corticosteroids.

Incidence is estimated at approximately 8 per 10 million vaccine doses, emphasizing the rarity of complications.

COVID-19 Vaccine-Induced Acute Encephalitis:

Two cases of mRNA-1273 vaccine-induced acute encephalitis are reported.

Clinical manifestations may be related to cytokine hyperproduction, and both patients improved with steroid therapy.

Early diagnosis and timely treatment are crucial for a favorable prognosis.


More recently posted case of mice with brain infection caused by the GX_P2V(short_3UTR) mutant of SARS-CoV-2 aligns with this and other previously discussed Neuroinflammatory cases: Vogt-Koyanagi-Harada (VKH) Syndrome and Fulminant Reversible Cerebrovascular Disorder. Other evidence of the virus targeting the brain include Vascular and Thrombotic Disorders (Stroke (including after more recent boosters), Brain Bleed, acute cerebrovascular disease), Neuropsychiatric: olfactory disorders,  Psychosis, Dementia; Neuromuscular and Motor Neuron Disorders such as ALS and Pain and Sensory Disorders including Complex Regional Pain Syndrome (CRPS). 


The presented case reports highlight the importance of vigilance for neurological complications post-COVID-19 vaccination, including encephalitis.


REFERENCES

Alabssi HA, Almulhim NF, Al-Omari M, Al Safar A. Anti NMDA Autoimmune Encephalitis Post COVID-19 Vaccination in A Pediatric Patient, A Case Report. Neuropediatrics. 2023 Nov 16. doi: 10.1055/a-2212-6936. Epub ahead of print. PMID: 37973159.

Gao JJ, Tseng HP, Lin CL, Hsu RF, Lee MH, Liu CH. Acute encephalitis after COVID-19 vaccination: A case report and literature review. Hum Vaccin Immunother. 2022 Nov 30;18(5):2082206. doi: 10.1080/21645515.2022.2082206. Epub 2022 Jun 14. PMID: 35700455; PMCID: PMC9621012.

Pakfetrat M, Malekmakan L, Najafi B, Zamani T, Mashayekh M. Post-COVID-19 vaccine acute encephalitis in an adult patient: A case report and literature review. Clin Case Rep. 2023 Feb 8;11(2):e6915. doi: 10.1002/ccr3.6915. PMID: 36789322; PMCID: PMC9909164.\

Zuhorn F, Graf T, Klingebiel R, Schäbitz WR, Rogalewski A. Postvaccinal Encephalitis after ChAdOx1 nCov-19. Ann Neurol. 2021 Sep;90(3):506-511. doi: 10.1002/ana.26182. Epub 2021 Aug 13. PMID: 34324214; PMCID: PMC8426979.

Shyu S, Fan HT, Shang ST, Chan JS, Chiang WF, Chiu CC, Chen MH, Shyu HY, Hsiao PJ. Clinical Manifestation, Management, and Outcomes in Patients with COVID-19 Vaccine-Induced Acute Encephalitis: Two Case Reports and a Literature Review. Vaccines (Basel). 2022 Jul 31;10(8):1230. doi: 10.3390/vaccines10081230. PMID: 36016118; PMCID: PMC9414071.

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