A Booster Dose of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Induced C7-C8 Radiculitis Leading to Hand Dysfunction: A Case Report

ABSTRACT

Case Diagnosis A 71-year-old female developed C7-C8 radiculitis with left hand weakness 4 days after receiving her booster dose of SARS-CoV-2 vaccine. Case Description or Program Description Patient with a significant past medical history of cervical fusion and bilateral carpal tunnel releases over 20 years ago presented to outpatient office because of decreased hand grip strength 4 days after receiving her booster dose of Pfizer-BioNTech SARS-CoV-2 vaccine. Her left hand weakness was spontaneous in onset, making her unable to flex her index finger and type. No pain or paresthesia. No trauma, swelling, color or temperature change in her left hand. Nerve conduction study and electromyography performed 19 days after the onset of her symptoms revealed acute greater than chronic changes mainly in distal muscles innervated by C7-C8 nerve roots, compatible with left C7-8 radiculopathy. MRI findings were chronic and compatible with her history of cervical fusion. Her clinical presentation was thought to be an inflammatory rather than mechanical etiology associated with the booster. Patient was referred to outpatient occupational therapy to help her restore hand function. Setting(s) Outpatient office of acute rehabilitation hospital Assessment/Results: Patient underwent occupational therapy and reported mild improvement in hand strength and function after 3 months of therapy. Discussion (relevance) The clinical course of this patient suggested an association between her symptoms and the booster dose of SARS-Cov-2 vaccine. It is possible that some component of the booster might have triggered an immune response and cross-reacted to the peripheral nerve system, leading to acute neuritis and the weakness of her hand. Conclusion(s) Neurologic complications after SARSCov- 2 vaccination is usually mild and self-limiting. We present a rare case of acute radiculitis that was associated with SARS-Cov-2 vaccination with residual impairment in function. Although the causality cannot be confirmed due to the lack of a biological marker, this case may help guide further research into a potential pathogenic mechanism.