ABSTRACT
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations have been administered worldwide, with occasional reports of associated neurological complications. Specifically, the impact of vaccinations on individuals with X-linked Charcot-Marie-Tooth disease type 1 (CMTX1) is unclear. Patients with CMTX1 can have stroke-like episodes with posterior reversible encephalopathy syndrome on magnetic resonance imaging (MRI), although this is rare. CASE SUMMARY: A 39-year-old man was admitted with episodic aphasia and dysphagia for 2 d. He received SARS-CoV-2 vaccination 39 d before admission. Physical examination showed pes cavus and reduced tendon reflexes. Brain MRI showed bilateral, symmetrical, restricted diffusion with T2 hyperintensities in the cerebral hemispheres. Nerve conduction studies revealed peripheral nerve damage. He was diagnosed with Charcot-Marie-Tooth disease, and a hemizygous mutation in the GJB1 gene on the X chromosome, known to be pathogenic for CMTX1, was identified. Initially, we suspected transient ischemic attack or demyelinating leukoencephalopathy. We initiated treatment with antithrombotic therapy and immunotherapy. At 1.5 mo after discharge, brain MRI showed complete resolution of lesions, with no recurrence. CONCLUSION: SARS-CoV-2 vaccination could be a predisposing factor for CMTX1 and trigger a sudden presentation.
ABSTRACT
Monitoring of side effects after coronavirus disease 2019 (COVID-19) vaccination has become an important issue for health systems worldwide to ensure its safety. Recently cases of deep vein thrombosis (DVT), vaccine-induced immune thrombotic thrombocytopenia, and autoimmune hepatitis have been described: the underlying pathophysiological mechanisms are still debated. We report on a patient who presented with DVT and acute hepatitis 8 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against COVID-19. The patient is a 56-year-old male who was already affected by a rare form of axonal Charcot-Marie-Tooth disease linked to MME (membrane metalloendopeptidase) gene variation and associated with mild symptoms. His blood exams did not have any evidence of thrombocytopenia but D-dimer, troponin T, alanine transaminase, and aspartate aminotransferase were abnormal, suggesting the presence of a blood clot and acute hepatitis. The patient was treated with subcutaneous enoxaparin for 15 days and with rivaroxaban for the following 8 months: his symptoms improved and his exams showed recanalization of the veins and a healed liver. The pathogenesis of thrombosis and hepatitis after vaccination is still unclear, especially in subjects affected by rare comorbidities and this may affect the safety of vaccination in this type of population. We highlight the importance of careful monitoring of side effects after vaccination: clinical suspicion must rise when patients complain of symptoms that differ from their usual presentation.