Sex: F
Vaccine: TDAP
Symptoms: Acute disseminated encephalomyelitis, Brain stem syndrome, CSF protein increased, CSF test abnormal, CSF white blood cell count increased
Clinical narrative: This case was reported in a literature article and described the occurrence of acute disseminated encephalomyelitis in a 56-year-old female patient who received dTpa vaccine. The patient's past medical history included pituitary adenoma (asymptomatic pituitary adenoma). On an unknown date, the patient received dTpa vaccine at an unknown dose. On an unknown date, 21 days after receiving dTpa vaccine, the patient experienced acute disseminated encephalomyelitis (serious criteria GSK medically significant), myelopathy (serious criteria GSK medically significant), brain stem dysfunction (serious criteria GSK medically significant), cerebellar disorder, pleocytosis and white matter hyperintensities. On an unknown date, the outcome of the acute disseminated encephalomyelitis, myelopathy, brain stem dysfunction, cerebellar disorder, pleocytosis and white matter hyperintensities were unknown. The reporter considered the acute disseminated encephalomyelitis, myelopathy, brain stem dysfunction, cerebellar disorder, pleocytosis and white matter hyperintensities to be possibly related to dTpa vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of acute disseminated encephalomyelitis in a 56-year-old female patient who was vaccinated with unspecified Tdap vaccine (manufacturer unknown). The patient had a history of asymptomatic pituitary adenoma. No information on patient's family history or concomitant medication was provided. On an unspecified date, the patient received unspecified Tdap vaccine (administration route and site unspecified; dosages unknown; batch number not provided). The age of vaccination was not provided. On an unspecified date between July and October 2016, 3 weeks after vaccination, the patient presented with subacute progressive multifocal neurological symptoms including myelopathic, brainstem, and cerebellar deficits. Repeated magnetic resonance imaging (MRIs) demonstrated multifocal and progressive T2/FLAIR hyperintensities of the cauda equina, long spinal cord segments, supratentorial and infratentorial brain white matter, with scattered associated contrast enhancement. Cerebrospinal fluid, clear (CSF) was notable for lymphocytic pleocytosis with 128 White blood cells (WBCs) (normal range not provided) and elevated protein (value and normal range not provided). Extensive infectious, neoplastic/paraneoplastic, and autoimmune workup was unrevealing. Subsequently, the clinical diagnosis of acute disseminated encephalomyelitis thought to be secondary to Tdap vaccination was made. Treatment was unknown. The outcome of the event was not reported. The authors considered the event of acute disseminated encephalomyelitis possibly associated to unspecified Tdap vaccine. The author concluded, "This two patient case series provides further evidence for a possible association between Tdap vaccination and acute demyelinating events." This is 1 of 2 valid cases in the same literature article.