Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Investigation, Magnetic resonance imaging head, Magnetic resonance imaging spinal, Myelitis transverse, Weight
Clinical narrative: incomplete transverse myelitis secondary to multiple sclerosis; This is a literature report for the following literature source(s):   A 32-year-old female patient received BNT162b2 (BNT162B2), on 16Jan2021 as dose number unknown, single (Batch/Lot number: unknown) at the age of 32 years for covid-19 immunisation. The patient's relevant medical history included: "chronic lower back pain" (unspecified if ongoing); "intermittent paresthesias of the right foot" (unspecified if ongoing); "gastric sleeve surgery", start date: Sep2019, stop date: Sep2019, notes: for obesity; "obesity" (unspecified if ongoing). The patient's concomitant medications were not reported. The following information was reported: MYELITIS TRANSVERSE (medically significant), 2 hrs after the suspect product(s) administration, outcome "recovering", described as "incomplete transverse myelitis secondary to multiple sclerosis". The patient underwent the following laboratory tests and procedures: evaluated: (16Mar2021) had reduced sharp touch sensation, notes: in her lower extremities and trunk with a T6 sensory level; Magnetic resonance imaging head: (28Feb2021) showed multiple small periventricular, notes: and subcortical white matter lesions with subtle involvement of the corpus callosum, as well as a small contrast-enhancing lesion within the right temporal lobe; Magnetic resonance imaging spinal: (21Mar2021) showed a number of hyperintense signal, notes: abnormalities, including the left dorsolateral cord at C-4, a well defined area of increased signal at T7-T8 with mild expansion of the cord and an ill-defined plaque on the right dorsolateral cord at T-10; Weight: (Sep2019) subsequent weight loss of 80 lbs. Therapeutic measures were taken as a result of myelitis transverse. Clinical courses: Here we wish to report an instance of TM associated with the Pfizer- BioNTech vaccine, and review other publically-reported cases associated with COVID-19 vaccines. A 32 year old woman was referred for evaluation of multiple sclerosis. She was in good health until 16Jan2021 when within two hours of receiving the Pfizer-BioNTech COVID-19 vaccine she experienced a numbing sensation on the left lip. Three days later, she noted initially numbness of her right foot, which travelled proximally to her waistline, then the left foot and peroneal area. In addition, she felt a "tired" sensation in her legs and slight urinary incontinence. An MRI scan of the brain performed on 28Feb2021 showed multiple, small periventricular and subcortical white matter lesions with subtle involvement of the corpus callosum, as well as a small contrast-enhancing lesion within the right temporal lobe. When she was evaluated on 16Mar, she had reduced sharp touch sensation in her lower extremities and trunk with a T6 sensory level. Her past medical history was significant for chronic lower back pain since her teens with intermittent paresthesias of the right foot and gastric sleeve surgery for obesity in Sep2019 with subsequent weight loss of 80 lbs. Spinal cord imaging performed on 21Mar showed a number of hyperintense signal abnormalities, including the left dorsolateral cord at C-4, a well- defined area of increased signal at T7-T8 with mild expansion of the cord and an ill-defined plaque on the right dorsolateral cord at T-10. The lesions did not enhance with contrast. She was diagnosed with incomplete transverse myelitis secondary to multiple sclerosis. Five days of high dose, intravenous methylprednisolone resulted mild improvement. She was referred for anti-CD20 treatment for long term therapy for MS. Discussion This is an example of incomplete TM secondary to multiple sclerosis, most likely triggered by the Pfizer-BioNTech vaccine. Our patient meets the MacDonald Criteria for multiple sclerosis based on her one clinical episode, multiple lesions in the brain and spine meeting the requirement for dissemination in space and an enhancing lesion in the brain meeting the requirement for dissemination in time ( Thompson et al., 2018 ). Given the probable presence of lesions in the brain and possibly the spinal cord pre-vaccination, our patient likely would have been diagnosed with radiographically isolated syndrome, a precursor to multiple sclerosis ( Hosseiny et al., 2020). Given the temporal relationship between COVID-19 vaccination and the onset of neurological symptoms, we believe that the vaccine triggered our patient's relapse. To date, more than 130 million persons have received at least one dose of the COVID-19 vaccine. Clearly, complications such as myelitis are rare. However, it is important that community physicians who will first encounter such patients be alert to the signs and symptoms of post vaccination myelitis so that such patients can receive expedient diagnosis and treatment.  No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender's Comments: Based on available information, although event could be related to the patient underlying medical conditions which could suggest a possible precursor to multiple sclerosis, however, based on the temporal relationship, a possibility that suspect vaccine bnt162b2 triggered the event Myelitis transverse, cannot be fully excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. 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