Sex: U
Vaccine: MMR, TTOX, VARZOS
Symptoms: Demyelination, Encephalitis brain stem, Immunisation reaction, Immunoglobulin therapy, Magnetic resonance imaging
Clinical narrative: probable tetanus; measles, mumps, and rubella; and varicella-zoster vaccine- induced MOGAD/anti-MOG multifocal demyelination; concomitant brainstem and Spinal motor attack; brainstem encephalitis; This serious case was reported in a literature article and described the occurrence of myelin oligodendrocyte glycoprotein antibody-associated disease in a adult patient who received MMR (MMR vaccine) for prophylaxis.   Co-suspect products included Herpes zoster (Zoster vaccine) for prophylaxis and TETANUS VACCINE for prophylaxis.   Additional patient notes included no autoimmune disease or cancer.   On an unknown date, the patient received MMR vaccine, Zoster vaccine and TETANUS VACCINE. On an unknown date, between 2 and 3 weeks after receiving MMR vaccine and Zoster vaccine, the patient experienced myelin oligodendrocyte glycoprotein antibody-associated disease (Verbatim: probable tetanus; measles, mumps, and rubella; and varicella-zoster vaccine- induced MOGAD/anti-MOG multifocal demyelination) (serious criteria GSK medically significant and clinically significant/intervention required), sensorimotor disorder (Verbatim: concomitant brainstem and Spinal motor attack) (serious criteria clinically significant/intervention required) and encephalitis brain stem (Verbatim: brainstem encephalitis) (serious criteria GSK medically significant and clinically significant/intervention required). The patient was treated with immunoglobulins nos (Ivig). The outcome of the myelin oligodendrocyte glycoprotein antibody-associated disease, sensorimotor disorder and encephalitis brain stem were resolved.   The reporter considered the myelin oligodendrocyte glycoprotein antibody-associated disease, sensorimotor disorder and encephalitis brain stem to be probably related to MMR vaccine and Zoster vaccine.     The company considered the myelin oligodendrocyte glycoprotein antibody-associated disease, sensorimotor disorder and encephalitis brain stem to be probably related to MMR vaccine and Zoster vaccine.   Additional Information: GSK receipt date: 30-MAR-2023 This case corresponds to the patient 18 reported literature article. The patient was a part of study which aimed to expand the literature on biologic- and vaccine-associated central nervous system (CNS) inflammation by examining the prevalence and clinical characteristics of iatrogenic CNS demyelinating and inflammatory events in patients referred to the neuroimmunology clinic over the past five years. Adult patients seen over five years (January 2017 to December 2021) at the tertiary neuroimmunology clinic were evaluated for potential iatrogenic demyelinating and inflammatory events secondary to tumor-necrosis-factor-alpha inhibitors (TNFAIs), immune-checkpoint inhibitors (ICIs), vaccines, and/or other immunomodulators. In patients with suspected iatrogenic CNS inflammation, the Adverse Drug Reaction Probability Scale was used to calculate a score indicating the probability of drug- or vaccine induced adverse events. The scale consists of 10 questions answered as "Yes," "No," or "Do not know," with different points (-1, 0, +1, or + 2) assigned to each. Depending on the patient's score, the iatrogenic event was labeled as definite (more than or equal to 9), probable (5-8), possible (2-4), or doubtful (less than or equal to 1). Potential iatrogenic events occurring more than one year after TNFAI, ICI, or vaccine exposure were included in the original analysis. However, these events were scored lower on the scale as they yielded an answer of "yes", which assesses the possibility of alternative explanations for the adverse reaction. A total of 422 patients seen at the neuroimmunology clinic for confirmed immune-mediated CNS disorders were screened for a potential iatrogenic etiology related to TNFAIs, ICIs, vaccinations, and/or other immunomodulators. In total, 27 potential iatrogenic events in 27 patients were observed accounting for 6.4% of all new referrals to the neuroimmunology clinic over the five-year period.  The patient was in early 30s at the time of neurological presentation. The patient received tetanus; measles, mumps, and rubella; and varicella-zoster vaccine- and after 2.5 weeks presented with Concomitant brainstem and spinal motor attack. The patient's iatrogenic diagnosis was reported as Probable tetanus; measles, mumps, and rubella; and varicella-zoster vaccine- induced Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The score was reported as 7.  The final disease course was monophasic.  The patient received plasma exchange and intravenous immunoglobulin (IVIG) and had full response to corticosteroids and/or immunotherapy. The influenza vaccine was most-frequently implicated in our vaccine-related events followed by COVID-19 mRNA vaccines and the tetanus vaccine. Vaccine-related events were more likely to resolve spontaneously than TNFAI- or ICI-related events, suggesting that vaccines may result in milder disease severity compared to other triggers. This article is not available for regulatory reporting due to copyright restriction.; Sender's Comments:  US-GSK-US2023GSK048173:Same reporter