Sex: M
Vaccine: TDAP
Symptoms: Acute disseminated encephalomyelitis, Anti-myelin-associated glycoprotein antibodies positive, CSF oligoclonal band absent, CSF protein increased, CSF white blood cell count increased
Clinical narrative: MOG Antibody-associated Hemorrhagic Acute Demyelinating Encephalo-myelitis (ADEM); Acute Demyelinating Encephalo-myelitis (ADEM); headaches; retroorbital pain; migraines; new-onset urinary retention; visual disturbance; vertigo; leukocytosis; lesions; neurological status deteriorated; multifocal T2 hyperintensities; multifocal T2 hyperintensities, associated hemorrhage; thrombosis of internal cerebral veins and venous sinuses; thrombosis of internal cerebral veins and venous sinuses; symptoms worsened; This serious case was reported in a literature article and described the occurrence of myelin oligodendrocyte glycoprotein antibody-associated disease in a 35-year-old male patient who received DTPa (Reduced antigen) (Tdap Vaccine) for prophylaxis. Literature Reference: On an unknown date, the patient received Tdap Vaccine. On an unknown date, 17 days after receiving Tdap Vaccine, the patient experienced myelin oligodendrocyte glycoprotein antibody-associated disease (Verbatim: MOG Antibody-associated Hemorrhagic Acute Demyelinating Encephalo-myelitis (ADEM)) (serious criteria hospitalization, GSK medically significant and clinically significant/intervention required), encephalomyelitis (Verbatim: Acute Demyelinating Encephalo-myelitis (ADEM)) (serious criteria hospitalization and GSK medically significant), headache (Verbatim: headaches) (serious criteria hospitalization), retro-orbital pain (Verbatim: retroorbital pain) (serious criteria hospitalization), migraine (Verbatim: migraines) (serious criteria hospitalization), urinary retention (Verbatim: new-onset urinary retention) (serious criteria hospitalization and GSK medically significant), visual disturbance (Verbatim: visual disturbance) (serious criteria hospitalization), vertigo (Verbatim: vertigo) (serious criteria hospitalization), leukocytosis (Verbatim: leukocytosis) (serious criteria hospitalization), skin lesion (Verbatim: lesions) (serious criteria hospitalization), neurological status deterioration (Verbatim: neurological status deteriorated) (serious criteria hospitalization and clinically significant/intervention required), hyperintensity in brain deep nuclei (Verbatim: multifocal T2 hyperintensities) (serious criteria hospitalization), hemorrhage (Verbatim: multifocal T2 hyperintensities, associated hemorrhage) (serious criteria hospitalization), cerebral venous thrombosis (Verbatim: thrombosis of internal cerebral veins and venous sinuses) (serious criteria hospitalization and GSK medically significant), thrombosis of venous sinuses (Verbatim: thrombosis of internal cerebral veins and venous sinuses) (serious criteria hospitalization and GSK medically significant) and condition aggravated (Verbatim: symptoms worsened) (serious criteria hospitalization and GSK medically significant). The patient was treated with methylprednisolone, prednisone, steroids and tocilizumab. The outcome of the myelin oligodendrocyte glycoprotein antibody-associated disease, encephalomyelitis, headache, retro-orbital pain, migraine, urinary retention, visual disturbance, vertigo, leukocytosis, skin lesion, neurological status deterioration, hyperintensity in brain deep nuclei, hemorrhage, cerebral venous thrombosis, thrombosis of venous sinuses and condition aggravated were resolving.   The reporter considered the myelin oligodendrocyte glycoprotein antibody-associated disease, encephalomyelitis, headache, retro-orbital pain, migraine, urinary retention, visual disturbance, vertigo, leukocytosis, skin lesion, neurological status deterioration, hyperintensity in brain deep nuclei, hemorrhage, cerebral venous thrombosis, thrombosis of venous sinuses and condition aggravated to be related to Tdap Vaccine.     The company considered the myelin oligodendrocyte glycoprotein antibody-associated disease, encephalomyelitis, retro-orbital pain, migraine, urinary retention, visual disturbance, vertigo, leukocytosis, skin lesion, neurological status deterioration, hyperintensity in brain deep nuclei, hemorrhage, cerebral venous thrombosis, thrombosis of venous sinuses and condition aggravated to be unrelated to Tdap Vaccine. The company considered the headache to be related to Tdap Vaccine.   Additional Information: GSK received date: 09-OCT-2024  A 35-year-old man, who had received a Tdap vaccination 14 days prior, presented to urgent care with headaches and retroorbital pain. Initially diagnosed with migraines and prescribed medication, he returned three days later with persistent symptoms, including new-onset urinary retention, visual disturbance, and vertigo. MRI revealed specific lesions, and initial CSF analysis indicated elevated protein and leukocytosis without oligoclonal bands. Treatment with IV methylprednisolone was followed by a discharge, but symptoms worsened, requiring additional IVMP and oral prednisone. As his neurological status deteriorated, he was intubated and transferred to a tertiary care center for further management. Repeat MRI showed multifocal T2 hyperintensities, associated hemorrhage, thrombosis of internal cerebral veins and venous sinuses. CSF showed WBC of 87 cells/l (85 percent polys), 89 mg/dl protein. MOG-IgG by CBA returned positive with a titer level of 1:1000, and CSF interleukin-6 (IL-6) was 17,904.6 pg/ml. As the patient did not respond to IV steroids, he underwent plasma exchange, and improved. The cerebral sinus venous thrombosis was presumed secondary to inflammation due to MOGAD. To prevent further relapses, he was started on tocilizumab. He had not experienced relapses and has sustained to improvement.; Sender's Comments: Case of 35-year-old male patient  with multiple events for Tdap Vaccine. There is insufficient evidence to establish a conclusive causal relationship.