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Kaulen LD, Doubrovinskaia S, Mooshage C, Jordan B, Purrucker J, Haubner C, Seliger C, Lorenz HM, Nagel S, Wildemann B, Bendszus M, Wick W, Schönenberger S. Neurological autoimmune diseases following vaccinations against SARS-CoV-2: a case series. Eur J Neurol 2021; 29:555-563. [PMID: 34668274 PMCID: PMC8652629 DOI: 10.1111/ene.15147] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/11/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Population-based studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger immune-mediated thrombotic thrombocytopenia (VITT) raising concerns for other autoimmune responses. The aim was to characterize neurological autoimmunity after SARS-CoV-2 vaccinations. METHODS In this single-centre prospective case study patients with neurological autoimmunity in temporal association (≤6 weeks) with SARS-CoV-2 vaccinations and without other triggers are reported. Clinical, laboratory and imaging data were collected with a median follow-up of 49 days. RESULTS In the study period 232,603 inhabitants from the main catchment area of our hospital (Rhein-Neckar-Kreis, county) received SARS-CoV-2 vaccinations. Twenty-one cases (new onset n = 17, flares n = 4) diagnosed a median of 11 days (range 3-23) following SARS-CoV-2 vaccinations (BNT162b2 n = 12, ChAdOx1 n = 8, mRNA-1273 n = 1) were identified. Cases included VITT with cerebral venous sinus thrombosis (n = 3), central nervous system demyelinating diseases (n = 8), inflammatory peripheral neuropathies (n = 4), myositis (n = 3), myasthenia (n = 1), limbic encephalitis (n = 1) and giant cell arteritis (n = 1). Patients were predominantly female (ratio 3.2:1) and the median age at diagnosis was 50 years (range 22-86). Therapy included administration of steroids (n = 15), intravenous immunoglobulins in patients with Guillain-Barré syndrome or VITT (n = 4), plasma exchange in cases unresponsive to steroids (n = 3) and anticoagulation in VITT. Outcomes were favourable with partial and complete remissions achieved in 71% and 24%, respectively. Two patients received their second vaccination without further aggravation of autoimmune symptoms under low-dose immunosuppressants. CONCLUSIONS In this study various neurological autoimmune disorders encountered following SARS-CoV-2 vaccinations are characterized. Given the assumed low incidence and mostly favourable outcome of autoimmune responses, the benefits of vaccinations outweigh the comparatively small risks.
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Affiliation(s)
- Leon D Kaulen
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Sofia Doubrovinskaia
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Berit Jordan
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Jan Purrucker
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Carmen Haubner
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Corinna Seliger
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Brigitte Wildemann
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Silvia Schönenberger
- Department of Neurology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
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