Optic Neuritis Following the BNT162b2 mRNA COVID-19 Vaccine in a Patient with Systemic Lupus Erythematosus Uncovering the Diagnosis of Neuromyelitis Optica Spectrum Disorders.

COVID-19 vaccinations have been given worldwide to save the lives of millions. However, several complications following different types of COVID-19 vaccinations were reported previously in the literature. Previous articles have reported multiple ocular complications following different types of COVID-19 vaccinations. In this article, we report a unique case in which the diagnosis of neuromyelitis optica spectrum disorders (NMOSD) was unveiled following vaccination with BNT162b2 mRNA COVID-19 vaccine and manifesting as acute optic neuritis in a patient with systemic lupus erythematosus (SLE). The temporal association of acute optic neuritis after receiving the BNT162b2 mRNA COVID-19 vaccine along with the serological evidence of NMOSD support this theory. The risk of triggering an occult autoimmune disorder in patients with an overactive immune system such as this patient should be studied to calibrate the benefits and risks of vaccination against COVID-19. Screening for aquaporin-4 antibodies in patients with SLE prior to vaccination against COVID-19 may be considered to prevent potentially devastating neurological disability in patients with premorbid occult NMOSD.

Rheumatoid Arthritis, Kartagener's Syndrome, and Hyperprolactinemia: Who Started It?

We report a case of an 18-year-old girl who presented to our hospital with history of recurrent respiratory infections, amenorrhea, and symmetric polyarthritis. She was diagnosed with rheumatoid arthritis (RA), Kartagener's syndrome (KS), and hyperprolactinemia. There have been very few case reports in the literature of RA occurring in the setting of KS, theoretically proposed to be due to chronic stimulation of the immune system by recurrent infections. Furthermore, hyperprolactinemia has been hypothesized to mirror RA disease activity and case reports of treatment with dopamine agonists have led to the speculation of whether or not they represent a new line of experimental treatment in the future. Our patient was found to have both KS and hyperprolactinemia together in the setting of RA, and based on our literature search, this is the first reported case of such a combination. This strikes a very intriguing question: are these three conditions interlinked by a yet to be defined association? And treatment of which condition leads to the resolution of the other?