Sex: F
Vaccine: COVID19
Symptoms: Demyelinating polyneuropathy, Demyelination
Clinical narrative: COMBINED CENTRAL AND PERIPHERAL DEMYELINATION; DEMYELINATING POLYNEUROPATHY; This spontaneous report was received from literature. This report concerned a 50 year old female. Aim- The aim of this report is to describe a case of CCPD with the clinical features, diagnostics results, treatments and outcomes. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (dose series 1) (suspension for injection, intramuscular, batch number was not reported) dose, start therapy date were not reported for covid-19 prophylaxis. The batch number was not reported. The company is unable to perform follow up to request batch/lot numbers. No concomitant medications were reported.  Method- A 50-year-old female, without remarkable medical history initially presented with subacute right sided weakness, dysarthria and ataxia as well as hand and foot paresthesias. Brain MRI demonstrated bilateral enhancing lesions in midbrain tegmentum. Extensive studies including CSF basic cell counts, cytology, cytometry, and paraneoplastic/autoimmune panel, heavy metals testing were all nonconclusive. Serum testing for ganglioside disorders and nodopathies was negative. She was treated with a three-day course of high dose IV steroids with significant improvement of her symptoms. One month later, the patient experienced short episodes of severe ataxia and weakness lasting 10-15 seconds despite improvement in midbrain lesion on MRI brain. Additionally, her paresthesias worsened. Nerve conduction studies were performed and demonstrated a length-dependent, sensorimotor, predominately demyelinating polyneuropathy. The patient was empirically treated with a second round of IV steroids with significant improvement. The action taken with covid-19 vaccine ad26.cov2.s  (dose series 1) was not applicable. The outcome of the combined central and peripheral demyelination and demyelinating polyneuropathy was not reported. Result- CCPD cases are rarely reported likely due to being underdiagnosed with unclear pathologies and guidelines for treatment. This case exhibits a midbrain demyelinating lesion followed by sensorimotor and demyelinating polyneuropathy. COVID-19 infection has been linked to both acute and central peripheral demyelinating pathologies. Retrospectively, three months before developing her symptoms, our patient acquired COVID-19 infection. One month prior to symptom onset she received Ad26COV2.S Janssen vaccination. Development of deficits after vaccination rather than after the viral infection may suggest a role for the immune complex mechanisms in CPPD pathogenesis, a theory that has yet to be verified with future cohort studies and advanced laboratory testing. This report was serious (Other Medically Important Condition).; Sender's Comments: ,V0:  -Demyelinating polyneuropathy. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event. Therefore, the WHO Causality is considered indeterminate. The company causality is considered unassessable.