Age: 29.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Loss of bladder sensation, Loss of personal independence in daily activities, Lumbar puncture abnormal, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal
Clinical narrative: Everything started on January 24th at about 7pm exactly 20 days post first Pfizer vaccine. No other changes or vaccines given since October (flu vaccine) was scheduled for 1/25/21 for second Pfizer dose. It all started when I was working at ER when I started to feel cold like it was in an ice bath and numbness in both feet. I went to discharge my patients when I realized ascending numbness and coldness from the feet was traveling upward. Within 5 hours (around midnight) I went to hospital due to having severe weakness to where I couldn?t walk and loss of bladder control. I was rushed to MRI of brain, cervical, thoracic, and lumbar. I also had blood work done and a lumbar puncture. I was admitted for a couple days to watching the ascending weakness and loss of feeling. My MRIs came back clear from any diseases such as transverse myelitis, MS, etc. My LP showed mild elevated protein at 54 (normal range 15-45), one tube elevated lymphocytes 100% (range 40-80%) and one tube elevated monocytes 50% (range 15-45%). Also CK-MB w/reflex was 352 (range 26-140). I was discharged on 2/26 at 5:30pm with a diagnosis of bilateral leg weakness and numbness. From this point on I was wheelchair bound at home and being cared for 24/7. After discharge some additional random symptoms started such as chills with no fever to where I slept in sweat pants and sweat shirts, leg spasms/ twitches, leg heaviness, severe lower back and hip pain, a loss of sensation while going pee or poo but not incontinent, and things like drop foot with the severe weakness and numbness . On 2/3/22 I started with double vision, blurry vision and pain behind my right eye. I went to ER and had repeat MRIs of brain, cervical, thoracic and lumbar with and without contrast and basic blood work and was sent home to follow up with Dr. on 2/9 and was discharged home. By 2/8 my strength started to get worse to where I couldn?t lift my kids. Finally saw Dr. neurology and MS specialist 2/9, he ran detailed neuro exams from head to toe, looked at both scans from both hospitals, all the blood work and LP results. He reported that I had severe hyper reflexes in both legs and Hoffman?s sign in both hands. My feet were completely numb and cold to where I couldn?t feel them or walk. Literally felt like everyday I was standing in a ice cold bath with no feeling of touch hot or cold sensation or pin pricks. He realized my loss of sensation was from my bra line down and included tingling in my hands and weakness in my arms. I was able to get up for the first time with a walker and take a few steps with assistance at this time. He then sent me to ER to be admitted and see their neuromuscular team to get further treatment. Upon arrival via wheelchair I was brought back to see the ER Doctor and re-did a neuro exam, some blood work and contacted the neurology team to come see me. I was then admitted to the hospital step down ICU under Dr with strict monitoring. On 2/10/21 The neuro team ordered another set of MRI of brain, cervical and thoracic with and without contrast due to a change in condition again since my last visit to hospital. They reviewed and compared studies with no changes. They scheduled me for MRI lumbar on 2/11/21 with and without contrast which came back no changes from previous MRI as well as another LP which everything that was off before was now normal. Everyday I would work with PT, OT and speech. I had no changes in speech and slowly got some strength back, and was able walk using a walker. I was then discharged home on 2/13 mid afternoon and was told I would do home health and follow up with their neurologist and Neuromusclar team once everything was resulted back. On 2/19/21 I saw my primary doctors office (nurse practitioner) where she checked up on the status of me, took me officially off work and on state disability, filled out paperwork for work and a handicapped pass. On 2/25/21 followed up with neurology, and discussed all my imaging and blood work. All CSF fluid came back normal, all labs were fine and wanted me to get an EMG to look for nerve damage. She also wanted a follow up with cardiology as my resting heart rate was 110-120 and would spike to 160s. On 3/1/21 Home health was started for physical therapy for strengthening and working on sensation for both legs. At this point I had almost full strength in my arms, still tingling in my hands and constant numbness and cold feeling in both feet and knees with severe sensitivity to cold, wind or touch on my legs. I had Home health twice a week every week for 2-3 weeks then started outpatient physical therapy which has been twice a week for 1.5 hours. On 3/5 I saw cardiology and was placed on a holt monitor for 48 hour monitoring. On 3/9 I had my EMG with Dr. and had a follow up with Dr. for 35 tubes of blood he had drawn for multiple diseases which both blood work and EMG came back negative. On 3/16 symptoms started to change from numbness to severe hypersensitivity to touch, severe shooting nerve pains, burning sensations, non stop tingling in hands, issues with temperatures either hot or cold, and swelling of both legs. On 3/17 I saw rheumatology that looked into everything said it was not lupus related as none of my inflammatory markers or lupus DNA strands were elevated and no lupus symptoms like rashes, ulcers in the mouth or tongue, hair loss or joint pain. He ordered more blood work and confirmed it was not a lupus flare up. He suggested doing a small nerve fiber biopsies. On 3/19/21 saw spinal orthopedics who reassured it has nothing to do with my spine, prescribed gabapentin for all the nerve pain and told me that neurology is who should be following me. On 3/26 I had an echocardiogram done due to the leg swelling and heart rates which came back negative for any heart problems and was told since the tachycardia is getting better to just continue watching it and was prescribed trazodone 25mg to help with sleep due to severe nerve pains, spasms and severe back and hip pains at night. On 4/1/21 was followed up again with neurology. Ordered small nerve fiber biopsy for may 18th, increased the gabapentin to 300 mg- 3 times a day and had me wean off cymbalta. I am still dealing with tingling, burning hot and cold sensitivities in both legs, still tingling in hands all day but strength is back to full. I am scheduled to hopefully return to work 5/30/2021 after being off since 1/24/2021.