Sex: F
Vaccine: COVID19
Symptoms: CSF lymphocyte count, CSF protein, Computerised tomogram head, Culture, Demyelination
Clinical narrative: demyelinating syndromes; The next morning, she experienced a generalized tonic clonic seizure; This is a literature report.  An 80-year-old female patient received BNT162b2 (BNT162B2), as dose 1, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history included: "chronic obstructive pulmonary disease" (unspecified if ongoing); "hypertension" (unspecified if ongoing); "hyperlipemia" (unspecified if ongoing); "anemia" (unspecified if ongoing); "persistent encephalopathy" (unspecified if ongoing); "left hemiparesis" (unspecified if ongoing); "generalized seizure" (unspecified if ongoing); "plasmapheresis" (unspecified if ongoing); "Hospitalization" (unspecified if ongoing); "neurological intensive care unit" (unspecified if ongoing); "cardiac arrest" (unspecified if ongoing), notes: She was transferred to our facility and on day 1 suffered. The patient's concomitant medications were not reported. The following information was reported: DEMYELINATION (death, hospitalization, medically significant), outcome "fatal", described as "demyelinating syndromes"; GENERALISED TONIC-CLONIC SEIZURE (hospitalization, medically significant), outcome "unknown", described as "The next morning, she experienced a generalized tonic clonic seizure". The patient underwent the following laboratory tests and procedures: Antibody test: Negative; Negative; Aspergillus test: Negative; Negative; Autopsy: widespread destructive sharply demarcated, notes: demyelinating le- sions with sheets of macrophages, associated with focal leptomeningeal and perivascular chronic inflammation composed of numerous T-cells, scant B-cells, and scattered plasma cells; revealed widespread destructive sharply demarcated, notes: demyelinating le- sions with sheets of macrophages, associated with focal leptomeningeal and perivascular chronic inflammation composed of numerous T-cells, scant B-cells, and scattered plasma cells; revealed widespread destructive sharply demarcated, notes: demyelinating le- sions with sheets of macrophages, associated with focal leptomeningeal and perivascular chronic inflammation composed of numerous T-cells, scant B-cells, and scattered plasma cells; Bacterial test: Negative; Biopsy bone marrow: unrevealing; Blood beta-D-glucan: Negative; Positive; Blood test: unrevealing; Bronchoscopy: Normal; revealed scant Aspergillus species,, notes: Stenotrophomonas maltophilia and no evidence of neoplasia; Computerised tomogram head: showed no abnormalities; CSF cell count: 33, notes: nucleated cells  A 3rd CSF examination; CSF glucose: 59 mg/dl; 28 mg/dl, notes: Repeat CSF examination; CSF lymphocyte count: 76 %, notes: CSF pleocytosis of 220; 72 %, notes: CSF pleocytosis of 28  Repeat CSF examination; CSF protein: 145 mg/dl; 610 mg/dl, notes: Repeat CSF examination; Culture: Negative; Negative; Diagnostic aspiration: revealed scant Aspergillus species,, notes: Stenotrophomonas maltophilia and no evidence of neoplasia; Electroencephalogram: revealed focal epileptiform discharges over, notes: the left posterior quadrant and diffuse delta-theta slowing of the back- ground; Endoscopy gastrointestinal: unrevealing; HIV antigen: Negative; Imaging procedure: lung nodules were identified; Blood serum infectious work for QuantiFERON: Negative; she exhibited decreased responsiveness and left, notes: hemiparesis; e was afebrile throughout, she exhibited, notes: occasional eye opening to voice and did not follow commands; Lumbar puncture: 220 [76% lymphocytes], protein of 145 mg/dL, and, notes: and glucose of 59 mg/dL; pleocytosis of 28 [72% lymphocytes],, notes: protein of 610 mg/dL, and glucose of 28 mg/dL; Magnetic resonance imaging head: revealed foci of signal hyperintensity in the, notes: right periatrial white matter, left temporooccipital periventricular white matter and left mesial temporal lobe; FLAIR sequence perintense lesions, notes: periventricularly in the left middle cerebellar peduncle [MCP] and medulla; demonstrated that the left middle cerebellar, notes: peduncle lesion was slightly increased in extent and conspicuity, with decreased enhancement; Magnetic resonance imaging spinal: revealed high T2 signal with expansile, notes: appearances throughout the spinal cord [ M, O], with associated contrast-enhancement, particularly in the ventral cervical cord; Positron emission tomogram: revealed abnormal radiotracer uptake involving, notes: the cervical spinal cord and to a lesser extent the thoracic spinal cord, in addition to the left cerebellar peduncle, and right mesial temporal lobe. Therapeutic measures were taken as a result of demyelination, generalised tonic-clonic seizure. The patient date of death was unknown. Reported cause of death: "demyelinating syndromes". The autopsy revealed "focal leptomeningeal and perivascular chronic inflammation composed of numerous t-cells, scant b-cells, and scattered plasma cells." (noninfective encephalitis); "widespread destructive sharply demarcated demyelinating lesions with sheets of macrophages" (demyelination).  Conclusion: This case depicts a seemingly fulminant course of a diffuse demyelinating syndrome characterized clinicopathologically as Marburg's variant of multiple sclerosis. There are several unique aspects of this case including the extremely rapid course, the unusual evolution of CSF abnormalities, with hypoglycorrhachia and markedly elevated protein. The proximity to vaccination is a pertinent association to document, though we cannot unequivocally prove causation.; Sender's Comments: Based on available information the causal role of suspect product BNT162B2 cannot be excluded for reported events. The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: demyelinating syndromes; Autopsy-determined Cause(s) of Death: widespread destructive sharply demarcated demyelinating lesions with sheets of macrophages; focal leptomeningeal and perivascular chronic inflammation composed of numerous T-cells, scant B-cells, and scattered plasma cells.