Medical Case Reports

The frequency of CNS neuroinflammatory events reported in the literature after both SARS-CoV-2 infection and COVID-19 vaccination is still largely unknown. While these conditions can occur spontaneously, they have also been reported following vaccinations, including those for influenza, hepatitis B, human papillomavirus, and COVID-19. Viruses and their vaccines  may unmask   CNS neuroinflammatory conditions.   A 47-year-old man with a history of psoriasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presented with 3 months of subacute lower extremity weakness, erectile dysfunction, and gait instability with falls. His symptoms started 2 weeks after receiving the second of his 2-shot primary mRNA vaccine series for coronavirus disease 2019 (COVID-19) vaccination, which he received 3 months after a mild case of COVID-19. He had no other relevant medical or family history and no recent travel. After evaluation by a urologist, he was prescribed ...

Vaccines and Related Biological Products Advisory Committee met yesterday  (1/26/2023), to continue investigating preliminary data indicating a possible stroke risk following simultaneous administration of the Pfizer Covid booster and the flu vaccine. FDA is launching a study to look into this possibility. Two weeks ago , we reviewed some of the VAERS reports in the 65+ age group. Multiple case reports describing stroke after COVID-19 vaccination have been published in medical literature. Some had unusual presentations.  A 43‐year‐old male patient with uneventful medical history was admitted 23 days after receiving a first dose of ChAdOx1 nCoV‐19 vaccine. Symptoms of headache, falls, and unsteadiness began 7 days after vaccination. At admission, he presented with reduced vigilance, multiple blue, or purple bruises in all extremities and left‐sided hemiparesis. The bruises had the typical clinical characteristics of hematomas after subcutaneous bleeding and were painful, ...

A 78-year-old healthy woman was presented with blurry vision in her left eye 1 day after receiving the third dose of the Pfizer-BioNTech COVID-19 vaccine. The ocular examination revealed an optic disc swelling and retinal thickening of the macula with subretinal fluid in the left eye. The fluorescein angiography revealed hyperfluorescence of the left optic disc. The neuroretinitis resolved gradually after taking azithromycin and prednisolone orally. unilateral neuroretinitis A 30-year-old female was diagnosed with bilateral acute anterior uveitis about a month after Pfizer COVID-19 booster vaccine and was started on prednisolone and cyclopentolate in both eyes. The symptoms had initially improved after a week of therapy, but a couple of weeks later she noticed that the visual acuity in the right eye precipitously dropped, which she described as “smoke” in her vision. She progressed to a serous retinal detachment involving the fovea in the left eye. Unilateral neuroretinitis is often ...

The  human leukocyte antigen  ( HLA ) genes  encode proteins essential for mounting an immune response.  Immune systems of people with specific HLA types may be better or worse at mounting an immune response and generating antibodies to specific proteins.  HLA-A11  (A11) is one of serotypes with 10.8% frequency in worldwide population. It's most  common in East Asia. One of its variations,  HLA-A*11, has been linked with vaccine-induced  subacute thyroiditis (V-SAT) . This rare transient inflammatory thyroid disease is usually associated with pain and tenderness of the gland, as well as generalized somatic symptoms: from anxieties,  difficulty swallowing, changes in appetite,  malaise and fatigue to  complete prostration for weeks or months if left untreated. HLA-A*11:01:01:01 was found to be significantly associated with the severity of COVID-19.   SAT is the most common thyroid dysfunction following SARS-CoV-2 vacc...

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a  rare disease with an annual incidence of approximately 20 per million population in Europe and North America. The aetiopathogenesis is complex and is mainly driven by the gene environment interactions. Genes associated with this condition include HLA-DQ (variations in which have been linked to asymptomatic COVID), IL-5 and GPA33. COVID-19 heralds a poor prognosis in those with preexisting AAV with over 50% patients having severe disease. Loss of smell is observed in AAV population more frequently (~50%) than in others (~35%).  70-year-old Chinese woman presented  with poor appetite and nausea 4 hours after receiving the first dose of CoronaVac vaccine. These symptoms progressively worsened, followed by fatigue and foamy urine 10 days later. Her medical history included hypertension, hyperlipidemia, and kidney stones. She had penicillin allergy and no family history of ANCA-associated vasculitis...

As fewer and fewer people opt for additional boosters of COVID-19 vaccine, are those who never had vaccine adverse events experiencing new side effects? VAERS reports many uneventful vaccinations even with extra doses given too soon after previous ones. Yet there are cases such as  abdominal pain , or Addisonian crisis  after the 5th dose. One case of systemic adverse reactions (14%, out of 7 respondents) was self-reported after the 5th booster in a survey-based study . The study also showed higher incidence of cutaneous reactions after 3rd vs 2nd dose of the same vaccine.  89 out of  234  vaccinated individuals  (38%)   who filled out  a web-based survey in Turkey  reported  at least one cutaneous adverse event related to the vaccination.  The responders cumulatively received 771 doses.  The mean number of vaccine dosages was 3.29 ± 0.76 (minimum:1, maximum:5). Sixty‐six (28.2%) cases had at least one accompanying systemi...

A 53-year-old healthy man received the first dose of the ChAdOx1 nCoV-19 vaccine (COVISHIELD) into his left deltoid muscle. He experienced pain in the left upper arm, followed by the right upper arm and bilateral calf muscles (left more than right). The pain gradually increased, restricting his daily activities. On the 11th day of vaccination, he had difficulty walking and moving his left arm. He also reported generalized muscle weakness, more pronounced in the proximal upper and lower limbs than the distal ones. His medical history was unremarkable with no evidence of COVID-19 infection in the past. Serologic testing yielded mildly increased serum creatine kinase (187 U/L, reference range 40–171 U/L) and alanine transaminase (50 U/L, reference range 10–40 U/L) concentrations. Serum bilirubin, aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and C-reactive protein levels were normal. Urine analysis excluded myoglobinuria.  On M...

Vogt-Koyanagi-Harada (VKH) syndrome is an autoimmune, multi-systemic disease which can occur due to viral infection or vaccination. It affects many body systems, including as the eyes, ears, skin, and the covering of the brain and spinal cord (the meninges). The most noticeable symptom is a rapid loss of vision. A 62-year-old healthy female patient developed a severe headache and tinnitus 2 days after receiving COVID-19 immunization with the Oxford-AstraZeneca Chimpanzee Adenovirus Vectored Vaccine ChAdOx1 nCoV-19 (AZD1222). Two days later she developed an acute loss of vision in both eyes.  Fundus examination showed a serous retinal detachment and optic disc hyperemia OU  (see Figure).  Four more cases that had a likely association between VKH disease and  severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  vaccination were reported this week in " Ocular Immunology and Inflammation" . Two patients had VKH symptoms within 1 and 2 weeks after rec...

In the period 27 December 2020 to 15 February 2021, about 29 400 of Norway's nursing home patients (aged  61–103)  were vaccinated with the mRNA vaccine BNT162b2. During the same period, the Norwegian Medicines Agency received 100 reports of suspected fatal adverse reactions to the vaccine. An expert group has examined the 100 reported deaths and concluded that 10 (10 %) are most likely related to the vaccine while there could be a possible link for other 26 individuals (26 %).  A  recent review  of other 38  cases linking the COVID-19 vaccines and the death found the following causes of death: vaccine-induced immune thrombotic thrombocytopenia (VITT) (32), myocarditis (3), acute disseminated encephalomyelitis (ADEM) (1), myocardial infarction (1), and rhabdomyolysis (1) . More than half of these cases were in elderly individuals. Unfortunately,  there were only a few publications on postmortem diagnostics of adverse events link...