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e describe a case of acute relapse in a woman with Multiple Sclerosis (MS) shortly after the mRNA COVID-19 vaccination. The patient received a diagnosis of MS in November 2016 at the MS Centre of the A. Cardarelli Hospital (South of Italy). Since that moment, her clinical conditions and pharmacological therapies have been managed at this MS centre where, according to national recommendations, in April 2021, the patient received the BNT162b2 vaccine. Almost 48 h after receiving the vaccine, the patient developed paraesthesia and weakness in her left arm and limbs. The neurological examination revealed walking difficulties while the MRI showed three new voluminous enhancing lesions. After having received methylprednisolone iv for 5 days, the patient’s neurological symptoms fully recovered. Along with the implementation of COVID-19 vaccination programmes among vulnerable population, further studies are needed in order to improve our knowledge on the benefit/risk ratio of COVID-19 vaccines.
Following the approval of COVID-19 vaccines across EU countries, vaccination programmes have been started in order to identify vulnerable people at highest risk from serious illness or death from COVID-19. According to recent recommendations from the Italian Ministry of Health and an Italian expert consensus, people with Multiple Sclerosis (MS), especially those with disabilities, progressive forms of the disease, older age, and comorbidities, were considered to be the category with the highest priority during the second phase of the Italian immunization programme (1, 2).
At this moment, very limited data on the effectiveness and safety profile of COVID-19 vaccines are available for MS patients. In this report, we describe a case of severe relapse occurred in a MS patient who had received COVID-19 vaccine. Written informed consent was obtained from the patient for the publication of any potentially identifiable images or data included in this article.
Case Presentation
In November 2016, a 26-year-old woman presented to the MS Centre of the A. Cardarelli Hospital (Italy) with tinnitus and dizziness. The MRI showed multiple periventricular, brain stem, and spinal cord hyperintense T2/FLAIR lesions, some of which were active. She was diagnosed with MS and started the treatment with fingolimod. In June 2018, after experiencing a clinical relapse, she started the first cycle of cladribine, which was well-tolerated. At 6-month, the MRI showed two new periventricular T2/FLAIR lesions with enhancement. No new lesions were present in the 1-year follow-up brain MRI. In June 2019, the patient was treated with a second cycle of cladribine tablets. Until March 2021 she showed neither clinical nor radiological progression of disease.
