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Neurological autoimmune diseases following vaccinations against SARS-CoV-2: a case series

Background and purpose Population-based studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger immune-mediated thrombotic thrombocytopenia (VITT) raising concerns for other autoimmune responses. The aim was to characterize neurological autoimmunity aft...

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Main Authors: Kaulen, Leon D. (Author) , Doubrovinskaia, Sofia (Author) , Mooshage, Christoph (Author) , Jordan, Berit (Author) , Purrucker, Jan (Author) , Haubner, Carmen (Author) , Seliger, Corinna (Author) , Lorenz, Hanns-Martin (Author) , Nagel, Simon (Author) , Wildemann, Brigitte (Author) , Bendszus, Martin (Author) , Wick, Wolfgang (Author) , Schönenberger, Silvia (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: European journal of neurology
Year: 2022, Volume: 29, Issue: 2, Pages: 555-563
ISSN:1468-1331
DOI:10.1111/ene.15147
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1111/ene.15147
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.15147
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Author Notes:Leon D. Kaulen, Sofia Doubrovinskaia, Christoph Mooshage, Berit Jordan, Jan Purrucker, Carmen Haubner, Corinna Seliger, Hanns-Martin Lorenz, Simon Nagel, Brigitte Wildemann, Martin Bendszus, Wolfgang Wick, Silvia Schönenberger
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Summary:Background and purpose Population-based studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger immune-mediated thrombotic thrombocytopenia (VITT) raising concerns for other autoimmune responses. The aim was to characterize neurological autoimmunity after SARS-CoV-2 vaccinations. Methods In this single-centre prospective case study patients with neurological autoimmunity in temporal association (≤6 weeks) with SARS-CoV-2 vaccinations and without other triggers are reported. Clinical, laboratory and imaging data were collected with a median follow-up of 49 days. Results In the study period 232,603 inhabitants from the main catchment area of our hospital (Rhein-Neckar-Kreis, county) received SARS-CoV-2 vaccinations. Twenty-one cases (new onset n = 17, flares n = 4) diagnosed a median of 11 days (range 3-23) following SARS-CoV-2 vaccinations (BNT162b2 n = 12, ChAdOx1 n = 8, mRNA-1273 n = 1) were identified. Cases included VITT with cerebral venous sinus thrombosis (n = 3), central nervous system demyelinating diseases (n = 8), inflammatory peripheral neuropathies (n = 4), myositis (n = 3), myasthenia (n = 1), limbic encephalitis (n = 1) and giant cell arteritis (n = 1). Patients were predominantly female (ratio 3.2:1) and the median age at diagnosis was 50 years (range 22-86). Therapy included administration of steroids (n = 15), intravenous immunoglobulins in patients with Guillain-Barré syndrome or VITT (n = 4), plasma exchange in cases unresponsive to steroids (n = 3) and anticoagulation in VITT. Outcomes were favourable with partial and complete remissions achieved in 71% and 24%, respectively. Two patients received their second vaccination without further aggravation of autoimmune symptoms under low-dose immunosuppressants. Conclusions In this study various neurological autoimmune disorders encountered following SARS-CoV-2 vaccinations are characterized. Given the assumed low incidence and mostly favourable outcome of autoimmune responses, the benefits of vaccinations outweigh the comparatively small risks.
Item Description:First published: 19 October 2021
Gesehen am 09.01.2023
Physical Description:Online Resource
ISSN:1468-1331
DOI:10.1111/ene.15147

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