Antibody-Positive Neuromyelitis Optica Spectrum Disorder After Second COVID-19 Vaccination: A Case Report. (preprint)

ABSTRACT

Background: We report a case of de novo aquaporin-4 positive neuromyelitis optica spectrum disorder following BNT162b SARS-CoV-2 vaccination. Case Presentation An 80-year-old South Asian man presented two days following his second dose of the Pfizer-BioNTech COVID-19 mRNA BNT162b2 vaccine with progressive left-sided leg weakness and numbness resulting in falls. MRI of the spine revealed a longitudinally extensive transverse myelitis from T3-T4 to T9-T10. Serum antibody testing revealed positive aquaporin-4 (AQP4) antibodies. He was diagnosed with de novo AQP4 positive neuromyelitis optica spectrum disorder (NMOSD) and was treated with high dose intravenous methylprednisolone and plasma exchange with some improvement. He was subsequently treated with mycophenolate mofetil and a slow steroid wean. Conclusions: Evidence suggests vaccinations may trigger de novo NMOSD or NMOSD relapses in some individuals. Ongoing vaccine surveillance and research are needed to understand the risk of NMOSD post-COVID-19 vaccinations further.