Sex: F
Vaccine: COVID19
Symptoms: Nausea, Nucleic acid test, Oxygen saturation, Physical examination, Protein total
Clinical narrative: TRANSVERSE MYELITIS; BELL'S PALSY; CHILLS; NAUSEA; This spontaneous report was received from literature: SARS-CoV-2 Vaccination-Induced Transverse Myelitis. 2021 Jul 25; 13(7): E16624. This report concerned a 44 year old female. The patient's height, and weight were not reported. The patient had no past history. The patient's pre-existing medical conditions included: Her family history was unremarkable for muscular disorders, multiple sclerosis, stroke and any rheumatological disorders. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration, batch number: Unknown and expiry date: Unknown) dose, start therapy date were not reported, 1 total for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. The patient was presented to the emergency department with a three-days history of worsening back pain associated with nausea and urinary retention. She also reported numbness and weakness in the lower extremities for the last two days along with low-grade fever, chills, and body aches for two to three days. On physical examination, blood pressure was 135/83 mmHg, heart rate of 78 beats per minute, temperature of 99.1 Fahrenheit, respiratory rate of 11 breaths per minute and oxygen saturation of 99% on room air. She was awake, alert, attentive, and oriented to time and person and did not have any nuchal rigidity, meningismus, or Lhermitte's sign. Her cranial nerves II-XII examination was grossly intact. She had normal muscle tone and strength in both upper and lower extremities with normal coordination and gait. Exaggerated (3+) deep tendon reflexes were noted in bilateral upper and lower extremities and positive Babinski signs were present bilaterally. Sensory examination was abnormal with decreased vibration in bilateral toes, and mild paresthesia in the neck and abdomen. The rest of the physical examination was unremarkable. Initial laboratory analysis showed an unremarkable complete metabolic profile, complete blood count, and a negative SARS-CoV-2 nucleic acid amplification test. The patient underwent magnetic resonance imaging (MRI) of the cervical, thoracic spine, and lumbar spine with and without contrast, showing increased signal throughout the spinal cord extending from the C2-3 segment into the upper thoracic spine (Transverse myelitis). She underwent MRI brain with and without contrast, which was unremarkable for any inflammatory process. Neurology services evaluated her and recommended starting high-dose methylprednisolone therapy for the next three days. She required multiple straight catheterizations due to urinary retention. The next day she had significant improvement in her symptoms. Lumbar puncture was performed with cerebrospinal fluid (CSF) analysis showing a white blood cell count of 227 µ/L, red blood cells of 25 µ/L, total cell count of 100 with 96% of lymphocytes, 3% of monocytes, and 1% of eosinophils. CSF chemistry analysis showed glucose of 71 mg/dL, protein of 43 mg/dL, albumin of 0.6 g/dL, and lactate dehydrogenase of 8 units/L. The rest of the workup, including the venereal disease research laboratory test, Toxoplasma gondii antibody, neuromyelitis optica IgG antibody, antinuclear antibody screen and cryptococcal antigen, were negative. CSF bacterial, viral, and fungal cultures were sent and were later reported as negative. The myelin basic protein was noted to be 2.8 mcg/L, and the (Immunoglobulin G) IgG index was 0.67. No oligoclonal bands were present. The CSF pathology showed small lymphocytes and rare monocytes. To prevent recurrence or exacerbation of myelopathy, neurology services decided to start her on plasma exchange for five treatments over 10 days after the completion of three days of pulse dose of methylprednisolone. While undergoing plasma exchange, she developed Bell's palsy, suggesting the persistence of the underlying inflammatory process despite three days of methylprednisolone and four sessions of plasma exchange. Repeat MRI cervical and thoracic spine with and without contrast was performed after five sessions of plasma exchange and showed a decrease in signal intensities in the cervical and thoracic spine depicting improvement in her condition. Treatment medications (dates unspecified) included: methylprednisolone. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from bell's palsy, chills, and nausea, and was recovering from transverse myelitis. This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0: 20210901278-covid-19 vaccine ad26.cov2.s -Transverse Myelitis; Bells Palsy This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210901278-covid-19 vaccine ad26.cov2.s -Chills; Nausea. This event(s) is labeled per RSI and is therefore considered potentially related.