Sub-acute Onset of Guillain-Barré Syndrome Post-mRNA-1273 Vaccination: a Case Report.

Ever since the start of the pandemic, SARS-CoV-2 has taken the lives of millions of people around the globe. Several COVID-19 vaccines have been developed with rapidity to prevent acquiring COVID-19 infection, hospitalizations, and deaths. The routine side effects of these vaccines are commonly known and non-severe. Few serious side effects such as thrombosis with thrombocytopenia syndrome (TTS) and Guillain-Barré syndrome (GBS) are increasingly reported particularly after inoculation with ChAdOx1 nCoV-19 (Oxford/AstraZeneca) and Ad26.COV 2.S (Johnson & Johnson's Janssen). Rare cases of GBS after BNT162b2 (Pfizer-BioNTech), an mRNA vaccine, are also reported. However, the true association of these cases to COVID-19 continues to be unclear and the safety of these vaccines continues to be great in preventing deaths from COVID-19 infection. We report a case of middle-aged female who had a gradual onset of lower extremity weakness with a nadir of symptoms reached 10 and 12 weeks after the onset. This protracted course (sub-acute) is atypical for a "classical" GBS. The presence of an antecedent event, autonomic symptoms such as hypotension, and the need for ventilator support favored the diagnosis of GBS than chronic inflammatory demyelinating polyneuropathy (CIDP). This is the first known case to be reported of sub-acute onset of Guillain-Barré syndrome after receiving the mRNA-1273 vaccine. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42399-022-01124-1.

A Case Report on Adult-Onset Still's Disease Successfully Treated With Tocilizumab: A Brief Review on its Safety and Efficacy.

Adult-onset Still's disease (AOSD) is a rare autoimmune disease of unknown etiology with systemic inflammatory manifestations consisting of a triad of fevers, evanescent skin rash, and arthritis. Although steroids are the first line of therapy, about 20%-30% of patients are refractory, intolerant, and or relapse during tapering or upon discontinuation of steroids. There are no clinical guidelines in treating such patients and treatment in these patients is challenging. Previously used biological agents have limited efficacy and hence there is a need for new therapies. Tocilizumab (TCZ), an interleukin (IL)-6 receptor antibody has been used with a clinical benefit and has shown to decrease the dose of steroids in patients with adult-onset still disease. The aim of this case report is to highlight the use of tocilizumab in relapsing and steroid intolerant cases of AOSD. The use of this drug in patients with AOSD is currently off-label. Randomized control studies can provide additional information that offers better visibility in treating AOSD patients who are steroid-resistant or intolerant. The rarity of disease possesses additional challenges in conducting these studies.

Reversible Cerebral Vasoconstriction Syndrome Due to Midodrine in a Patient with Autonomic Dysreflexia.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological condition that typically presents with a sudden-onset thunderclap headache associated with or without focal neurological deficits. The diagnosis is established by the presence of reversible segmental or diffuse cerebral vasoconstriction on diagnostic cerebral angiogram. Autonomic dysreflexia is a known complication resulting from spinal cord injury. It manifests as episodes of flushing, headache, and fluctuations in blood pressure. Midodrine is an alpha-1 agonist that causes vasoconstriction and is commonly used in patients with autonomic dysreflexia. Here, we report the case of a young woman with a history of autonomic dysreflexia, who presented with a thunderclap headache and was subsequently diagnosed with reversible cerebral vasoconstriction syndrome.

Mononeuropathy due to Entrapment of Dorsal Cutaneous Peroneal Nerve: Clinical, Electrophysiological, and Imaging Findings.

Peroneal neuropathy is the most common mononeuropathy encountered in the lower extremities. Isolated injuries to the dorsal cutaneous peroneal nerve (DCPN) are uncommon, and most of the reported cases are due to trauma or iatrogenic causes. We report a case of a middle-aged woman who presented with a nine-month history of tingling sensation over the dorsum of her left foot with normal electromyography (EMG) findings and was subsequently diagnosed with entrapment of the DCPN at the ankle by ultrasonographic examination.

Horner Syndrome Due to Spontaneous Internal Carotid Artery Dissection.

Horner syndrome is a constellation of neurological findings consisting of ipsilateral ptosis, miosis, and anhidrosis. Partial Horner syndrome, comprising ipsilateral ptosis and miosis in the absence of anhidrosis, is a well-documented but uncommon manifestation of internal carotid artery dissection. We report the case of a 42-year-old male patient who presented with ipsilateral ptosis and miosis and was subsequently diagnosed with internal carotid artery dissection. In this case report, we discuss the anatomy of the oculosympathetic pathway and the pharmacological diagnosis for a better understanding of the localization of the lesions causing Horner syndrome.

Mal de Debarquement Syndrome: A Case Report.

Mal de Debarquement syndrome (MdDS) is an uncommon neurological disorder seen in women, mostly in their fourth decade of life. It is characterized by a constant sensation of swaying or motion after one disembarks from a vehicle such as a ship or plane following a lengthy trip. These symptoms temporarily subside when the patient is subjected again to passive motion like driving a car. There are no definitive diagnostic tests for Mal de Débarquement syndrome. It is a diagnosis of exclusion and does not have an effective treatment. The symptoms usually resolve spontaneously in about a year. We report a case of a 47-year-old female who presented with a feeling of imbalance following about a four-week cruise, which temporarily subsides during a bicycle ride or a car drive. We report this case, as this condition may not be well-known and probably under-reported. Prospective travelers should be warned and patients can perhaps be cautiously reassured.

Recurrent Opportunistic Infections in a Thymectomised Patient with Myasthenia Gravis and Good's Syndrome.

We report the case of a 65-year-old man with myasthenia gravis, who developed recurrent opportunistic infections following thymectomy and immunosuppressive therapy. Subsequent evaluation including immunological studies, flow cytometry, and bone marrow studies confirmed the diagnosis of Good's syndrome. The patient was successfully treated with intravenous immunoglobulin (IVIG) and has remained stable with a monthly IVIG regimen. Good's syndrome should be strongly suspected when patients with myasthenia gravis develop recurrent opportunistic infections, especially after discontinuation of immunosuppressive therapy. Any delay in diagnosis can be life-threatening in such patients. Serum immunoglobulin levels and flow cytometry should be considered part of the initial diagnostic evaluation in patients with myasthenia gravis and an anterior mediastinal mass prior to the initiation of immunosuppressive therapy.

A Case Report on Pituitary Apoplexy Presenting as Acute Kidney Injury.

Pituitary apoplexy is characterized by the acute ischemic or hemorrhagic infarction of the pituitary gland. Acute kidney injury is a less recognized complication associated with pituitary apoplexy but occasionally can be a presenting condition in patients with pituitary apoplexy. Here we discuss the case of a patient who presented with significant volume depletion, admitted with acute kidney injury, and was later diagnosed with pituitary apoplexy.