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1.
Journal of the American Academy of Dermatology ; 87(3):AB26, 2022.
Article in English | EMBASE | ID: covidwho-2031370

ABSTRACT

Background: Vaccine hesitancy is common and increasingly relevant in the current medical landscape. Simply based on volume, dermatology practices intersect with the community more than most medical providers. At risk populations for vaccine preventable illnesses are also relatively commonplace in dermatology clinics, as is the practice of injectable therapeutics. Based on these factors, we hypothesize that dermatology clinics have a unique opportunity to positively impact the public health of the population they serve through vaccine administration. Methods: From May until August 2021, 220 patients received a single or two-dose series of the COVID-19 vaccine at their local dermatology clinic as part of a vaccine outreach initiative. A 5-question survey was provided to these patients exploring perspectives, satisfaction, and interest in further vaccinations if offered. Compliance with second dose regimens was also measured. Results: Preliminary data shows high degrees of satisfaction with vaccines administered at the dermatology office. 97% of eligible patients followed through on second dose regimens. “Convenience” and “comfort with the practice” were the two most common listed reasons for vaccine compliance. 88% of patients stated they would receive other vaccines at their dermatology clinic if recommended and available. Conclusion: Based on these data, it appears that Dermatology clinics can positively impact vaccine hesitance and play a role in public health through offering certain vaccines at their facilities. This data could be extrapolated to make an argument for expanded vaccine administration targeted toward conditions salient to everyday dermatology practice (eg, vaccines for human papillomavirus and varicella zoster).

2.
Frontiers in Immunology ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2009860

ABSTRACT

Allelic diversity of human leukocyte antigen (HLA) class II genes may help maintain humoral immunity against infectious diseases. In this study, we investigated germline genetic variation in classical HLA class II genes and employed a systematic, unbiased approach to explore the relative contribution of this genetic variation in the antibody repertoire to various common pathogens. We leveraged a well-defined cohort of 800 adults representing the general Arab population in which genetic material is shared because of the high frequency of consanguineous unions. By applying a high-throughput method for large-scale antibody profiling to this well-defined cohort, we were able to dissect the overall effect of zygosity for classical HLA class II genes, as well as the effects associated with specific HLA class II alleles, haplotypes and genotypes, on the antimicrobial antibody repertoire breadth and antibody specificity with unprecedented resolution. Our population genetic studies revealed that zygosity of the classical HLA class II genes is a strong predictor of antibody responses to common human pathogens, suggesting that classical HLA class II gene heterozygosity confers a selective advantage. Moreover, we demonstrated that multiple HLA class II alleles can have additive effects on the antibody repertoire to common pathogens. We also identified associations of HLA-DRB1 genotypes with specific antigens. Our findings suggest that HLA class II gene polymorphisms confer specific humoral immunity against common pathogens, which may have contributed to the genetic diversity of HLA class II loci during hominine evolution.

3.
Annals of the Rheumatic Diseases ; 81:917-918, 2022.
Article in English | EMBASE | ID: covidwho-2008906

ABSTRACT

Background: Opportunistic and chronic infections can arise in the context of treatment used for Autoimmune Rheumatic Diseases (ARDs). Although it is recognized that screening procedures and prophylactic measures must be followed, clinical practice is largely heterogeneous, with relevant recommendations not currently developed or disparately located across the literature. Objectives: To conduct a systematic literature review (SLR) focusing on the screening and prophylaxis of opportunistic and chronic infections in ARDs. This is preparatory work done by members of the respective EULAR task force (TF). Methods: Following the EULAR standardised operating procedures, we conducted an SLR with the following 5 search domains;1) Infection: infectious agents identifed by a scoping review and expert opinion (TF members), 2) Rheumatic Diseases: all ARDs, 3) Immunosuppression: all immunosuppressives/immunomodulators used in rheumatology, 4) Screening: general and specifc (e.g mantoux test) terms, 5) Prophylaxis: general and specifc (e.g trimethop-rim) terms. Articles were retrieved having the terms from domains 1 AND 2 AND 3, plus terms from domains 4 OR 5. Databases searched: Pubmed, Embase, Cochrane. Exclusion criteria: post-operative infections, pediatric ARDs, not ARDs (e.g septic arthritis), not concerning screening or prophylaxis, Covid-19 studies, articles concerning vaccinations and non-Εnglish literature. Quality of studies included was assessed as follows: Newcastle Ottawa scale for non-randomized controlled trials (RCTs), RoB-Cochrane tool for RCTs, AMSTAR2 for SLRs. Results: 5641 studies were initially retrieved (Figure 1). After title and screening and removal of duplicates, 568 full-text articles were assessed for eligibility. Finally, 293 articles were included in the SLR. Most studies were of medium quality. Reasons for exclusion are shown in Figure 1. Results categorized as per type of microbe, are as follows: For Tuberculosis;evidence suggests that tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic DMARDs (csDMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. Conversion of TST/IGRA occurs in about 10-15% of patients treated with biologic DMARDs (bDMARDs). Various prophylactic schemes have been used for latent TB, including isoniazide for 9 months, rifampicin for 4 months, isoniazide/rifampicin for 3-4 months. For hepatitis B (HBV): there is evidence that risk of reactivation is increased in patients positive for hepatitis B surface antigen. These patients should be referred for HBV treatment. Patients who are positive for anti-HBcore antibodies, are at low risk for reactivation when treated with glucocorticoids, cDMARDs and bDMARDs but should be monitored periodically with liver function tests and HBV-viral load. Patients treated with rituximab display higher risk for HBV reactivation especially when anti-HBs titers are low. Risk for reactivation in hepatitis C RNA positive patients, treated with bDMARDs is low. However, all patients should be referred for antiviral treatment and monitored periodically. For pneumocystis jirovecii: prophylaxis with trimeth-oprim/sulfamethoxazole (alternatively with atovaquone or pentamidine) should be considered in patients treated with prednisolone: 15-30mg/day for more than 4 weeks. Few data exist for screening and prophylaxis from viruses like E B V, CMV and Varicella Zoster Virus. Expert opinion supports the screening of rare bugs like histoplasma and trypanosoma in patients considered to be at high risk (e.g living in endemic areas). Conclusion: The risk of chronic and opportunistic infections should be considered in all patients prior to treatment with immunosuppressives/immunomod-ulators. Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics. Collaboration between different disciplines is important.

4.
Autoimmunity ; 2022.
Article in English | EMBASE | ID: covidwho-2008396

ABSTRACT

Antagonism of the neonatal Fc receptor (FcRn) by efgartigimod has been studied in several autoimmune diseases mediated by immunoglobulin G (IgG) as a therapeutic approach to remove pathogenic IgGs. Whereas reduction of pathogenic titres has demonstrated efficacy in multiple autoimmune diseases, reducing total IgG could potentially increase infection risk in patients receiving FcRn antagonists. The objective of this study was to analyse the effect of FcRn antagonism with efgartigimod on existing protective antibody titres and the ability to mount an immune response after vaccine challenge. Serum levels of total IgG and protective antibodies against tetanus toxoid (TT), varicella zoster virus (VZV), and pneumococcal capsular polysaccharide (PCP) were measured in all patients enrolled in an open-label trial of efgartigimod for the treatment of pemphigus. Vaccine specific-responses were assessed by measuring changes in IgG titres in patients with generalised myasthenia gravis (gMG) who were treated with efgartigimod and who received influenza, pneumococcal, or coronavirus disease 2019 (COVID-19) vaccines during participation in the double-blind trial ADAPT or open-label extension, ADAPT+ (n = 17). FcRn antagonism reduced levels of protective anti-TT, anti-VZV, and anti-PCP antibodies and total IgG to a similar extent;anti-TT and anti-VZV titres remained above minimally protective thresholds for the majority of patients, (10/12) 83% and (14/15) 93% respectively. Protective antibodies returned to baseline values upon treatment cessation. Antigen-specific IgG responses to influenza, pneumococcal, and COVID-19 immunisation were detected in patients with gMG who received these vaccines while undergoing therapy with efgartigimod. In conclusion, FcRn antagonism with efgartigimod did not hamper generation of IgG responses but did transiently reduce IgG titres of all specificities.

5.
Journal of Cutaneous Immunology and Allergy ; 2022.
Article in English | EMBASE | ID: covidwho-2007095

ABSTRACT

Background: Since the campaign of vaccination against COVID-19 was started, a wide variety of cutaneous adverse effects after vaccination has been documented worldwide. Varicella zoster virus (VZV) reactivation was reportedly the most frequent cutaneous reaction in men after administration of mRNA COVID-19 vaccines, especially BNT162b2. Aims: A patient, who had persistent skin lesions after BNT162b2 vaccination for such a long duration over 3 months, was investigated for VZV virus and any involvement of vaccine-derived spike protein. Materials & Methods: Immunohistochemistry for detection of VZV virus and the spike protein encoded by mRNA COVID-19 vaccine. PCR analysis for VZV virus. Results: The diagnosis of VZV infection was made for these lesions using PCR analyses and immunohistochemistry. Strikingly, the vaccine-encoded spike protein of the COVID-19 virus was expressed in the vesicular keratinocytes and endothelial cells in the dermis. Discussion: mRNA COVID-19 vaccination might induce persistent VZV reactivation through perturbing the immune system, although it remained elusive whether the expressed spike protein played a pathogenic role. Conclusion: We presented a case of persistent VZV infection following mRNA COVID-19 vaccination and the presence of spike protein in the affected skin. Further vigilance of the vaccine side effect and investigation for the role of SP is warranted.

6.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005711

ABSTRACT

Background: Infections occur with up to twofold increased risk in patients with monoclonal gammopathy of undetermined significance (MGUS) and tenfold increased risk in multiple myeloma (MM). To reduce risk, revaccination following autologous hematopoietic cell transplantation (AHCT) is recommended to restore humoral immunity. We have previously shown that vaccine titers after AHCT have prognostic significance. In the COVID era, reliable clinical data about antibody titers is relevant yet scarce. We investigated the significance of different vaccine titers in newly diagnosed patients in different stages of the disease. Methods: The study population comprised of 77 patients with MGUS, smoldering multiple myeloma (SMM) and MM who were seen at a tertiary cancer center from 2018- 2022. All patients had antibody titers (B. pertussis, Diptheria, H. Influenzae B, Hepatitis, Influenza, Meningitis, Mumps, Rubeola, Rubella, Poliovirus, S. pneumoniae, Varicella Zoster and Tetanus) tested at the time of diagnosis, prior to start of treatment if indicated. Titers were interpreted in accordance with the manufacturers' recommendations. Patient characteristics were compared using the Kruskal- Wallis and Fisher's exact tests. Associations with % titer positivity were evaluated using the Kruskal- Wallis test. Results: There was significant difference in antibody titer positivity between the different patient groups (51.4% in MGUS, 40.5% in SMM and 34.2% in MM) (p < 0.001). There was no difference in antibody titer positivity depending on age, sex or race. Among individual pathogens, there was a significant difference between the three groups in regards to titers for Diphtheria, Mumps, Poliovirus 3, Strep pneumoniae 19, Strep pneumoniae 56 and Varicella Zoster. Conclusions: Antibody titers for vaccine preventable diseases are significantly different between patients with MGUS, SMM and MM at the time of diagnosis, with MGUS having the highest and MM having the lowest positivity. Patient related factors such as age, sex or race were not associated with antibody titer positivity. Current guidelines for revaccination are not extended to patients with MGUS and SMM and can be considered in prospective trials.

7.
Journal of the Korean Ophthalmological Society ; 63(7):625-629, 2022.
Article in Korean | Web of Science | ID: covidwho-1979029

ABSTRACT

Purpose: We report a case with bilateral, ocular inflammatory adverse reactions developing a few hours after COVID-19 vaccination. Case summary: A 70-year-old woman complained of headache and sudden visual impairment (both eyes) a few hours after COVID-19 vaccination (Astrazeneca). She had undergone bilateral cataract surgery 4 days before vaccination and her eyesight was good immediately after surgery. The best-corrected visual acuities (BCVA) were 0.2 and 0.1 in the right and left eyes, respectively. Diffuse corneal edema, anterior chamber reactions, inflammatory fibrinoid membranes on the anterior surfaces of the intraocular lenses (IOLs), and cystoid macular edema were observed in both eyes. The anterior chamber and IOL fibrinoid reactions much improved 7 days after the prescription of topical and oral corticosteroids. The aqueous humor polymerase chain reaction was positive for varicella zoster virus (VZV) in both eyes. The BCVA improved to 20/30 in the right eye and 20/50 in the left eye after 3 months of additional treatment. However, the cystoid macular edema did not improve. Conclusions: In patients with a history of herpes zoster infection, adverse ocular inflammatory reactions associated with VZV may occur immediately after COVID-19 vaccination.

8.
European Journal of Neurology ; 29:26, 2022.
Article in English | EMBASE | ID: covidwho-1978444

ABSTRACT

Primary angiitis of the central nervous system (PACNS) is an inflammatory disease affecting exclusively small and medium-sized vessels of the central nervous system. CNSvasculitis may also occur in systemic diseases like giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis, or Behçet syndrome. The most common presenting symptoms of CNS vasculitis are multifocal symptoms associated with recurrent episodes of ischemia or hemorrhage, encephalopathy-related cognitive and affective abnormalities, and headaches. Diagnostic work up of CNS vasculitis includes MRI, CSF examination, digital subtraction angiography and brain biopsy. High-resolution, contrast-enhanced, compensated and fat-saturated MRI imaging of the cerebral vessel walls (black-blood imaging) may be of some value for the detection of CNS-vasculitis. Patients with normal CSF findings are unlikely to have CNS vasculitis. Brain biopsy should be performed in suspected PACNS. Important differential diagnoses include reversible cerebral vasoconstriction syndrome, moyamoya angiopathy and infectious vasculopathies (VZV, SarsCoV2, borreliosis, bacterial endocarditis). The adherence to diagnostic criteria and the avoidance of inappropriate therapies are essential. Treatment recommendations for CNS-vasculitis include glucocorticoids in combination with cyclophosphamide or rituximab;however, randomized clinical trials of PACNS treatment do not exist. Induction therapy is recommended for 6 to 12 months. After remission is achieved, treatment may be continued with substances as mycophenolate mofetil, methotrexate, or azathioprine. Repeated clinical, CSF- and neuroradiological monitoring is needed to determine the individual duration of maintenance therapy.

9.
Ocul Immunol Inflamm ; : 1-12, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1967747

ABSTRACT

PURPOSE: To describe herpetic ocular infections following SARS-CoV-2 vaccinations. METHODS: A retrospective study of herpetic ocular infections after BNT162b2mRNA vaccination and a literature review. RESULTS: A cohort of five patients: three varicella zoster virus (VZV) and two herpes simplex virus (HSV) cases, as well as 19 literature cases: 9 cases of VZV and 10 cases of HSV post BNT162b2mRNA, AZD1222, mRNA-1273, and CoronaVac vaccinations. All cases presented within 28 days post vaccination. Most VZV and HSV cases (15/19) reported in the literature presented post first vaccine dose, while in our cohort 2 VZV cases presented post second dose and both HSV cases and one VZV case post third dose. The most common presentations were HZO with ocular involvement and HSV keratitis. All eyes had complete resolution; however, one had retinal detachment and three corneal scars. CONCLUSION: Herpetic ocular infections may develop shortly after SARS-CoV-2 vaccinations. Overall, the outcome is good.

10.
Clinical and Experimental Neuroimmunology ; 2022.
Article in English | EMBASE | ID: covidwho-1968077

ABSTRACT

Various effective monoclonal antibodies (mAbs) have been approved for both multiple sclerosis (MS) and anti-aquaporin-4-seropositive neuromyelitis optica spectrum disorders worldwide, including in Japan. As these newer mAbs have distinct modes of action that effectively suppress the recurrence of inflammation and slow disability progression, they can modulate and interfere with the protective immune response against pathogens, resulting in various infectious complications. Among various mAbs, natalizumab (NTZ) has the highest risk of causing progressive multifocal leukoencephalopathy (PML), a rare but fatal opportunistic brain infection caused by John Cunningham polyomavirus. Switching from NTZ to B-cell-depleting mAbs, such as ocrelizumab, is also a possible risk factor for PML development. Alemtuzumab carries the risk of reactivation of varicella-zoster virus (VZV);therefore, prophylactic acyclovir treatment is required. NTZ has also been associated with VZV reactivation. Eculizumab can cause severe meningococcal infection due to Neisseria meningitis, and vaccination prior to treatment induction is required. Attention to the reactivation of hepatitis B or Mycobacterium tuberculosis is also needed during mAb therapy. Additionally, in the era of severe acute respiratory syndrome coronavirus 2 infection (COVID-19), the risk for of developing severe COVID-19 may be associated with some mAbs, such as B-cell-depleting agents. Thorough understanding and mitigation strategies for infectious risks are essential.

11.
Sexually Transmitted Infections ; 98:A25, 2022.
Article in English | EMBASE | ID: covidwho-1956902

ABSTRACT

Case A 20-year old was seen at the height of the Omicron wave of the COVID-19 pandemic with a two day history of a first episode of painful genital ulceration. Her last sexual contact was one week previously. She had no other symptoms and no medical or drug history. There was bilateral inguinal lymphadenopathy and a unilateral 1cm slightly indurated shallow vulval ulcer with slough. She was treated empirically for secondarily infected primary herpes. Three days later she presented with increased pain and negative HSV PCR and STI/ BBV tests. She had large bilateral genital ulcers (figure 1) and was admitted. Repeat swabs for HSV, VZV and syphilis were negative. She had a neutrophilia, raised CRP and negative EBV and CMV IgM. A routine nasopharyngeal swab identified SARS-CoV-2 and a full respiratory virus PCR panel was otherwise negative. She disclosed a sore throat and fevers the week before the onset of her vulval symptoms but was reassured by negative home antigen tests. She had received the second dose of an mRNA COVID-19 vaccine four months previously but no booster. She was discharged after five days and treated with a reducing course of oral steroids. At four weeks her ulcers were healing well. Discussion There are few published cases of Lipschütz ulcers associated with COVID-19 and this case adds to the burgeoning evidence of the possible dermatological manifestations of the disease and crucially it illustrates the value of prompt access to sexual health services during the pandemic. (Figure Presented).

12.
Journal of Clinical Periodontology ; 49:84, 2022.
Article in English | EMBASE | ID: covidwho-1956753

ABSTRACT

The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.

13.
British Journal of Dermatology ; 186(6):e245, 2022.
Article in English | EMBASE | ID: covidwho-1956705

ABSTRACT

A 17-year-old-male presented to an acute medical take with severe mouth pain, and poor oral intake. This occurred 6 days after a positive SARS CoV-2 test, with which he had only mild symptoms. He was unvaccinated against SARS CoV-2. Clinically, he had a severe ulcerated mucositis present on his lips, buccal mucosa and lateral edge of the tongue. He had not been commenced on any new medications prior. There was no other skin involvement. Viral swabs for herpes simplex virus and varicella zoster virus were negative. His presentation was in keeping with a reactive infectious mucocutaneous eruption (RIME) secondary to COVID-19 infection. This typically presents with severe painful mucositis with mild nonspecific skin manifestations. This entity was previously classically described in association with Mycoplasma infection. Since the emergence of COVID-19, several cutaneous manifestations have been observed. There is only one other published case of RIME associated with COVID-19 infection. This was in a similarly aged male presenting with severe mucositis and lack of significant cutaneous involvement. The patient was treated with a 5-day course of 40 mg oral prednisolone, which led to complete resolution with no scarring or subsequent recurrence. A literature review revealed only one other case of RIME associated with COVID-19, which was successfully treated with oral steroid therapy. The case exemplifies new, emerging presentations related to COVID-19 infection that may present to dermatology services.

14.
IDCases ; 29: e01563, 2022.
Article in English | MEDLINE | ID: covidwho-1926492

ABSTRACT

As a result of the COVID-19 pandemic, mRNA vaccination has become widespread. Recently, it has been suggested that instances of herpes zoster increase following mRNA COVID-19 vaccination. Herein, we describe the first case of zoster sine herpete (ZSH) after mRNA vaccination for COVID-19. A 60-year-old Japanese immunocompetent man presented with fever, fatigue, headache, cervical pain, and lumbar pain, which developed after receiving a second dose of BNT162b2 mRNA COVID-19 vaccination. Whereas most symptoms improved with symptomatic treatment, headache and numbness of the right forehead persisted in areas innervated by the trigeminal and second and third cervical nerves. Based on positive results of an enzyme-linked immunosorbent assay examination for anti-VZV IgM, ZSH was diagnosed, and amitriptyline improved the patient's symptoms. Diagnosis of ZSH is challenging due to the lack of a characteristic herpes zoster rash. Physicians should be aware that ZSH can develop after mRNA vaccination.

15.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925455

ABSTRACT

Objective: This case report describes a longitudinally-extensive transverse myelitis after Moderna SARS-CoV-2 vaccination. Background: Transverse myelitis (TM) is an inflammatory spinal cord syndrome presenting with acute-to-subacute neurological deficits. A lesion spanning three or more vertebral segments on imaging is considered “longitudinally-extensive.” The TM differential is broad-- among these etiologies, vaccination is a rare but recognized entity. Design/Methods: 60-year-old, right-handed man with chronic right hemisphere stroke with residual left hemiparesis admitted for four days of bilateral lower extremity numbness progressing to weakness and urinary and bowel incontinence 10 days after receiving his second Moderna SARS-CoV-2 vaccination. Examination showed hypotonic lower extremities, proximal greater than distal weakness, a T9 dermatome sensory level, perineal numbness, mildly-reduced rectal tone, and preserved reflexes. MRI spine revealed a longitudinallyextensive, non-enhancing T2-hyperintense lesion spanning T8-T12. CSF analysis demonstrated 5 white blood cells, 1271 red blood cells, 124 glucose, and 55 protein. Aside from mildly elevated ESR and CRP, extensive serum and CSF work-up for other causes of myelopathy, including nutritional/toxic (copper, zinc, heavy metals), infectious (RPR/VDRL, HIV, HTLV, HSV, VZV, West Nile), and rheumatologic (anti-Jo, anti-Mi-2, anti-Ro/La, anti-smith, anti-Scleroderma, anti-dsDNA, anti-ribosomal P, anti-RNP), were unremarkable. Anti-NMO and anti-MOG antibodies were negative. He improved with methylprednisolone 1000 mg daily for five days suggesting an autoimmune etiology. Results: NA Conclusions: Transverse myelitis has a broad presentation and differential, requiring detailed history-taking to determine the cause as management differs between etiologies. SARS-CoV-2 and post-vaccination are known etiologies for TM. Given the timing of our patient's symptom onset after vaccination and thorough exclusion of other causes, we postulate a potentially novel case of TM associated with the Moderna SARS-CoV-2 vaccine. Though post-vaccination myelopathy is potentially debilitating if untreated, it is rare, and the benefits of vaccination appear to outweigh the risks.

16.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925311

ABSTRACT

Objective: We aim to determine the prevalence and clinical characteristics of iatrogenic CNS inflammation associated with vaccinations at a tertiary neuroimmunology clinic and compare the frequency of these events before and after the COVID-19 pandemic. Background: Various vaccines are implicated in rare demyelinating events. Although influenza is the most commonly-implicated vaccine, an increasing number of CNS inflammatory events are linked to SARS-CoV-2 vaccines. Design/Methods: We analyzed consecutive patients seen over 4 years (2017-2021) at a tertiary neuroimmunology clinic who were screened for iatrogenic CNS inflammation secondary to vaccinations. In patients with suspected iatrogenic events, the Naranjo Adverse Drug Reaction Probability Scale was used to score the probability of vaccine-related events as doubtful, possible, probable, or definite. Results: In total, 419 patients were seen over 4 years and were screened. Eleven cases were identified, and the total prevalence was 2.6% (82% female, average age 56+/- 18 years). Most events (10, 91%) were scored as probable. The following disease phenotypes were identified: multiple sclerosis relapse (6, 55%), optic neuritis (1, 9%), monophasic MOGAD (1, 9%), transverse myelitis relapse (1, 9%), seropositive NMOSD (1, 9%), and autoimmune encephalitis (1, 9%). The vaccines included influenza (n=4), SARS-CoV-2 mRNA (n=3), swine flu (n=1), and HPV (n=1). Two patients were exposed simultaneously to multiple vaccines (tetanus, MMR, and VZV;tetanus, hepatitis A, and meningococcal vaccines). Spontaneous resolution occurred in 36% of events, complete response to corticosteroids/immunotherapy in 46%, partial response in 9%, and unresponsiveness in 9%. Finally, 8 patients (73%) had relapsing disease and 3 patients (27%) had monophasic disease. Conclusions: Post-vaccination iatrogenic CNS inflammation is a rare but distinct neuroimmunological disease spectrum mostly involving spontaneous recovery or responsiveness to corticosteroids. We did not identify an excess of SARS-CoV-2 vaccine-related events. The rare occurrence and predominantly favorable prognosis suggest the benefit of vaccination outweighs the neurological risks, especially during the COVID-19 pandemic.

17.
Cureus ; 14(5): e25375, 2022 May.
Article in English | MEDLINE | ID: covidwho-1924644

ABSTRACT

Varicella-zoster virus (VZV) may cause aseptic meningitis in the pediatric age group. We describe a pediatric case of aseptic meningitis with a substantial increase of the paired serum antibody to VZV in which the child did not have skin rash during the course of illness. The patient was a 13-year-old boy without any history of exposure to VZV who was admitted with headache, vomiting, and low-grade fever. He had received one dose of varicella vaccine derived from the Oka/Biken strain (vOka) at the age of one year. Cerebrospinal fluid (CSF) analysis on admission revealed an elevated white blood cell count at 609/mm3 with 99.6% mononuclear cells. As his symptoms resolved after lumbar puncture alone, he was discharged on the seventh day of hospitalization without receiving any specific medication. Serum VZV-IgG titer was found to be substantially elevated after two weeks. VZV infection and reactivations associated with vaccination, as well as past infections, should be included in the differential diagnoses of pediatric aseptic meningitis, even in the absence of skin rash in the entire course. Polymerase chain reaction (PCR) testing for VZV DNA in CSF should be performed in all cases, if available.

18.
Therapeutic Advances in Neurological Disorders ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1916867

ABSTRACT

The safety and efficacy of hyperacute reperfusion therapies in childhood stroke due to focal cerebral arteriopathy (FCA) with an infectious and inflammatory component is unknown. Lyme neuroborreliosis (LNB) is reported as a rare cause of childhood stroke. Intravenous thrombolysis (IVT) and endovascular therapy (EVT) have not been reported in LNB-associated stroke in children. We report two children with acute stroke associated with LNB who underwent hyperacute stroke treatment. A systematic review of the literature was performed to identify case reports of LNB-associated childhood stroke over the last 20 years. Patient 1 received IVT within 73 min after onset of acute hemiparesis and dysarthria;medulla oblongata infarctions were diagnosed on magnetic resonance imaging (MRI). Patient 2 received successful EVT 6.5 hr after onset of progressive tetraparesis, coma, and decerebrate posturing caused by basilar artery occlusion with bilateral pontomesencephalic infarctions. Both patients exhibited a lymphocytic cerebrospinal fluid (CSF) pleocytosis and elevated antibody index (AI) to Borrelia burgdorferi. Antibiotic treatment, steroids, and platelet inhibitors including tirofiban infusion in patient 2 were administered. No side effects were observed. On follow-up, patient 1 showed good recovery and patient 2 was asymptomatic. In the literature, 12 cases of LNB-associated childhood stroke were reported. LNB-associated infectious and inflammatory FCA is not a medical contraindication for reperfusion therapies in acute childhood stroke. Steroids are discussed controversially in inflammatory FCA due to LNB. Intensified antiplatelet regimes may be considered;secondary prophylaxis with acetyl-salicylic acid (ASA) is recommended because of a high risk of early stroke recurrence.

19.
Swiss Medical Weekly ; 152(SUPPL 258):31S, 2022.
Article in English | EMBASE | ID: covidwho-1913215

ABSTRACT

We report a 15-year-old boy presenting at our emergency department with acute onset of dysarthria and prior headache, rotary vertigo, nausea, vomiting and gait disturbance for 2 days. 18 days earlier he was tested positive for SARS CoV-19. Physical examination showed pronounced dys-arthria, nystagmus, absent reflexes, dysmetria and ataxia. Laboratory findings showed relative lymphocytosis with a negative C-reactive pro-tein, normal coagulation and elevated liver enzymes (AST, ALT, GGT). Drug screening was negative. First suspicion was postinfectious cerebellitis and he was admitted to IMC for observation. Subsequently, vomiting fre-quency rose, hence cMRI was performed, but showed no abnormalities. Miller-Fisher syndrome was suspected, however CSF examination showed no cytoalbumin dissociation, but discrete mononuclear cell count eleva-tion. Ceftriaxone and acyclovir were administered empirically. In addition, intravenous immunoglobulin and corticosteroids were given to treat viral cerebellitis/encephalitis. Due to suggestive atypical lymphocytes in the blood count, EBV testing was performed and serologies were positive. Multiple CSF viral/bacterial testings (Borrelia burgdorferi, Enterovirus, VZV, HSV 1/2) showed slightly positive EBV (PCR), congruent with blood results. Additionally, SARS-CoV-19 IgG were positive. The patient's condi-tion barely improved, a follow up cMRI showed no changes. Mobilization was fostered with a wheel chair and physical therapy. After two and a half weeks, he was discharged to pediatric neurorehabilitation in order to im-prove dysarthria, ataxia and address neuropsychological abnormalities. Two months after the diagnosis he is walking without aids but still shows trunk ataxia and dysarthria. He is still making constant progress and will hopefully recover completely. Neurological manifestation of EBV infection is extremely rare with the ma-jority of cases described in children. Nevertheless, some neurological manifestations have already been described including encephalitis, cere-bellitis, meningitis, transverse myelitis, and Guillain-Barré syndrome. These manifestations can occur alone or in the setting of infectious mon-onucleosis. In our case a co-infection of SARS-Cov-19 and EBV or a reactivation of EBV due to SARS-Cov-19 is possible as cause of the cerebellitis. Treatment op-tions were fully employed, but the recovery presented a slow course.

20.
Swiss Medical Weekly ; 152(SUPPL 258):27S, 2022.
Article in English | EMBASE | ID: covidwho-1913188

ABSTRACT

Background Vulvar ulcers are mostly caused by sexually transmitted microorganisms, like T. pallidum, HSV and, occasionally, HIV. When genital ulcers occur in not sexually active women and girls, Lipschutz's acute vulvar ulceration is the leading cause. This benign and self-remitting condition is a non-sex-ually acquired condition, generally related to flu-like infections or mono-nucleosis syndrome. A concurrent EBV infection occurs in nearly 50% of cases. Local hygiene, ulcers care and pain control are the mainstay of man-agement of this condition. Case study A 14-year-old-girl, not sexually active, arrives to the emergency referring since four days severe pain in the genital area, enhanced during voiding and associated with vulvar ulcers. No other symptoms are referred. A two days therapy with acyclovir has shown to be ineffective. Local inspection of external genitalia shows 4 ulcerated lesions <5 mm, with no active bleeding and a slight oedema of the right labium minus. Hymen shows to be intact. A diagnosis of Lipschutz ulcers is hypothesize. Some tests are thus performed: microbiological cultures of the lesions are negative for HSV and VZV. Blood panel shows mild isolated lymphopenia and CRP is 2 mg/L. Serologies for CMV, HBV, HCV, HIV, Toxoplasmosis and T. pallidum are negative. Serologies for EBV turn out positive for past infection. PCR for SARS-Cov-2 is otherwise positive. We set home symptomatic therapy with ibuprofen alternating with co-paracetamol, and cold-water vulvar ir-rigation for voiding. A spontaneous resolution takes place in ten days. Due to her moving to Italy and to problems related to non-recognition of swiss immunity documents, the girl had to take the third dose of vaccine (BioN-Tech/Pfizer) one month after healing. Four days later the ulcers recur in the same place, although with eased symptoms. Conclusion According with other literature cases, Covid-19 infection could represent a likely explanation for this clinical situation. The recurrence after vaccine represents a strong evidence for this hypothesis. We therefore suggest to always include Covid-19 infection in the lab tests from now on, while screening for Lipschutz ulcers. Although benign, this clinical picture is con-firmed to be highly invalidating and do not respond to any specific ther-apy. The treatment of pain is critical. It is always important to consider whether pain management can be carried out at home, if hospitalization and eventual catheterization can be avoided.

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