ABSTRACT
A 26-year-old Japanese woman developed a fever, myalgia and gait disturbance one day after receiving the second dose of the mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. A neurological examination revealed symmetrical weakness and myalgia in proximal lower limbs, and a blood examination showed prominent elevation of creatinine kinase. Magnetic resonance imaging (MRI) revealed a high signal intensity in the thigh muscles on short-tau inversion recovery images, and antibody testing revealed positive findings for anti-signal recognition particle (SRP) antibody. Thus, anti-SRP antibody-positive immune-mediated myopathy was diagnosed. We initiated immunotherapy, and she was ultimately able to walk stably.
Subject(s)
COVID-19 , Muscular Diseases , Female , Humans , Adult , Signal Recognition Particle , SARS-CoV-2 , 2019-nCoV Vaccine mRNA-1273 , COVID-19 Vaccines/adverse effects , Myalgia , Autoantibodies , COVID-19/prevention & control , Muscular Diseases/etiology , Muscular Diseases/drug therapy , VaccinationABSTRACT
The patient in Case 1 was a 25-year-old female nurse. While she was working at a day-care, she fell down shortly after using a barcode reader. This was followed by a tonic-clonic seizure. The seizure spontaneously stopped after approximately 5 minutes. However, consciousness impairment continued for about 30 minutes. The patient in Case 2 was a 30-year-old female nurse. During the night shift at her workplace, she found it impossible to stand up after staring at the red flashing lights from a barcode reader. The patient was also disoriented, as indicated by her inability to recall her colleague's name. The patient's condition gradually improved and she became fully conscious soon after the episode. We believe that the barcode reader led to photosensitivity in both cases. Barcode readers that emit red flashing lights are thought to have a high potential for triggering photosensitivity. A person is highly likely to display photosensitivity while using the device in a hospital ward. Therefore, special attention is required to avoid photosensitive seizures induced by barcode readers with red flashing lights.
Subject(s)
Consciousness Disorders/etiology , Durable Medical Equipment , Equipment and Supplies/adverse effects , Light/adverse effects , Occupational Exposure/adverse effects , Seizures/etiology , Adult , Anticonvulsants/administration & dosage , Electroencephalography , Female , Humans , Seizures/diagnosis , Seizures/drug therapy , Treatment Outcome , Valproic Acid/administration & dosageABSTRACT
We report a case of repeated cerebral hemorrhage associated with administration of rivaroxaban and apixaban. A 74-year-old man had undergone catheter ablation for non-valvular paroxysmal atrial fibrillation in 2 years prior. Warfarin treatment was continued after successful catheter ablation, and was then changed to rivaroxaban in 1 year prior. Three months later, he developed subcortical cerebral hemorrhage in the right occipital lobe and pharmacotherapy was changed to apixaban. At the current presentation, he complained of headache and left visual field defect, and was admitted to our hospital. Computed tomography of the head revealed recurrent hematoma at the same site as the previous hemorrhagic lesion. Administration of apixaban was subsequently stopped. Magnetic resonance imaging of the head revealed no vascular anomalies around the hemorrhagic lesion, except for two microbleeds in the left cerebral cortex, suggesting amyloid angiopathy. We report the current case from the perspective of whether anticoagulation should be continued after successful catheter ablation, and whether anticoagulation is appropriate in patients with microbleed signals in the cerebral cortex.
