Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Akathisia, Anti-GAD antibody, Antibody test, CSF cell count, Chorea
Clinical narrative: Continuous chorea movement/dyskinesia/dysphagia/dysarthria/dystonia; Akathisias (inability to stay motionless); Myoclonus at rest; This literature-non-study case was reported in a literature article and describes the occurrence of CHOREA (Continuous chorea movement/dyskinesia/dysphagia/dysarthria/dystonia), AKATHISIA (Akathisias (inability to stay motionless)) and MYOCLONUS (Myoclonus at rest) in a 57-year-old female patient who received SPIKEVAX NOS (SPIKEVAX NOS) for COVID-19 prophylaxis.    Concurrent medical conditions included Type 2 diabetes mellitus, Hypertension, Dyslipidemia, Gastritis, Major depressive disorder, Generalized anxiety disorder and Drug abuser.    On an unknown date, the patient received second dose of SPIKEVAX NOS (SPIKEVAX NOS) (unknown route) 1 dosage form. On an unknown date, the patient experienced CHOREA (Continuous chorea movement/dyskinesia/dysphagia/dysarthria/dystonia) (seriousness criterion hospitalization), AKATHISIA (Akathisias (inability to stay motionless)) (seriousness criterion hospitalization) and MYOCLONUS (Myoclonus at rest) (seriousness criterion hospitalization). The patient was treated with ROPINIROLE at an unspecified dose and frequency; METHYLPREDNISOLONE at a dose of UNK, qod and RITUXIMAB at a dose of 375 milligram/sq. meter once a day. At the time of the report, CHOREA (Continuous chorea movement/dyskinesia/dysphagia/dysarthria/dystonia), AKATHISIA (Akathisias (inability to stay motionless)) and MYOCLONUS (Myoclonus at rest) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Anti-GAD antibody: more than 250 IU (0-5). On an unknown date, Antibody test (0-31 pmol/L): 104 pmol/L. On an unknown date, CSF cell count: showed normal white blood cells but elevated  protein. Open pressure: 17 cm.. On an unknown date, Magnetic resonance imaging head: with and without contrast showed no significant findings (Non-revealing).. On an unknown date, Protein total (15-45 mg/dl): 193 mg/dl. On an unknown date, White blood cell count (0-8 per cubic millimetre): 4 per cubic millimetre.     For SPIKEVAX NOS (SPIKEVAX NOS) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications were reported.  The patient received her second Moderna booster 14 days prior to presentation. Five days prior to presentation, she developed involuntary body movements.  A trial of various medications led to the discovery that her symptoms were only responsive to the dopaminergic agent ropinirole. The patient tested positive for VGKC (Serum VGKC antibody (0-31) 104 pmol/L ) and GAD antibodies (Serum GAD antibody (0-5) >250 IU). Her symptoms (both chorea and myoclonus) improved after methylprednisolone, plasmapheresis (once every other day for five cycles), and a course of rituximab 375 mg/m2 . By the time she was discharged home, after 45 days, she was able to feed herself, use the bathroom with minimal assistance, and ambulate with a walker. She was discharged on low dose of ropinirole.  The study concluded the short-term and long-term effects of COVID-19 infection and mRNA vaccine in the human body are still unknown. It was only through rigorous reporting and analysis of data that a firm relationship between these movement disorders and COVID-19 can be elucidated epidemiologically. This reporting may link strange presentations with potentially treatable immunological processes. The current observations, as others have pointed out, may turn out to be von Economo disease of the 21st century. There was a possibility that this time around, equipped with current science and through a globally interconnected community, we can confirm COVID-19 as one of the pathogens involved in developing von Economo disease.   This case was linked to US-MODERNATX, INC.-MOD-2024-764162 (E2B Linked Report).  Company Comment: This is a literature non-study case concerning a 57-year-old, female patient with relevant medical history of Type 2 diabetes mellitus, Hypertension, Dyslipidemia, Gastritis, Major depressive disorder, Generalized anxiety disorder and Drug abuser who experienced the serious (due Hospitalization) unexpected events of Chorea, Akathisia and Myoclonus. The events occurred approximately 15 days after the second dose of mRNA-1273 vaccine. Five days prior to presentation, she developed involuntary body movements. The movements were a combination of myoclonus at rest, dystonia when she tried to hold objects, and an otherwise continuous chorea movement. She also had akathisias. It progressively worsened, and she became bedridden secondary to her inability to stand; the chorea had affected her lower extremities. She was also dysarthric, dysphagic, and unable to use her limbs functionally. Despite her motor decline, she remained oriented and coherent throughout; she was constantly involved in intelligent and meaningful discussions of her diagnosis and management. MRI of the brain with and without contrast showed no significant findings. Cerebral spinal fluid (CSF) analysis showed normal white blood cells but elevated protein. She tested positive for VGKC and GAD antibodies. The patient was treated with methylprednisolone, plasmapheresis (once every other day for five cycles), ropinirole and a course of rituximab 375 mg/m2. By the time she was discharged home, after 45 days, she was able to feed herself, use the bathroom with minimal assistance, and ambulate with a walker. She was discharged on low-dose ropinirole. The outcome of the events was reported as recovering. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender's Comments:  US-MODERNATX, INC.-MOD-2024-764162:same reporter(78 year old male)