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      LETTER TO EDITOR Year : 2023  |  Volume : 71  |  Issue : 5  |  Page : 1059-1060

Longitudinally Extensive Myelitis Onset in Subacute Combined Degeneration Combined with a Novel Coronavirus Vaccine Injection

Jian-Cheng Peng, Jun Li, Ming Zhou, Si-Huan Zhu, Ke-Fan Li
Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine; Graduate School of Anhui University of Traditional Chinese Medicine, Hefei, China

Date of Submission17-Oct-2022Date of Decision14-Jun-2023Date of Acceptance18-Jun-2023Date of Web Publication18-Oct-2023

Correspondence Address:
Jun Li
Anhui University of Traditional Chinese Medicine, #117 Meishan Street, Shushan District Hefei, 230037
China

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0028-3886.388127

How to cite this article:
Peng JC, Li J, Zhou M, Zhu SH, Li KF. Longitudinally Extensive Myelitis Onset in Subacute Combined Degeneration Combined with a Novel Coronavirus Vaccine Injection. Neurol India 2023;71:1059-60
How to cite this URL:
Peng JC, Li J, Zhou M, Zhu SH, Li KF. Longitudinally Extensive Myelitis Onset in Subacute Combined Degeneration Combined with a Novel Coronavirus Vaccine Injection. Neurol India [serial online] 2023 [cited 2023 Oct 19];71:1059-60. Available from: https://www.neurologyindia.com/text.asp?2023/71/5/1059/388127

Sir,

Subacute combined degeneration (SCD) is the most common neurological manifestation of vitamin B12 deficiency and is usually secondary to autoimmune gastritis (AIG).[1] Currently, there are no reports about the associations between SCD with AIG and the coronavirus vaccine.

A 48-year-old male patient initially experienced slight numbness in his right little finger for a week. After receiving the first dose of inactivated (Sinovac) coronavirus disease 2019 (COVID-19) vaccine (Vero Cell) injection, he complained of palpitations, chest tightness, and extremities weakness at that time. In 2 weeks, he developed numbness and weakness from the neck to toes, unsteady gait, and fell easily. Laboratory findings showed mild megaloblastic anemia. The vitamin B12 level was normal. IgG antibody against parietal cells was positive (1:32). Electromyography indicated damaged sensory fibers of the bilateral sural nerve, bilateral superficial peroneal nerve, right median nerve, and right ulnar nerve. A significant increase in T1 and T2 values and an inverted V-shaped sign were observed in the dorsal spinal cord from cervical to lumbar [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f. As a result of a gastroscope, atrophy of the gastric mucosa, and abnormal pepsinogen and gastrin-17 levels, SCD and AIG were diagnosed. After treatment with methylprednisolone and vitamin B12, all laboratory indicators returned to normal gradually. The abnormal signals in the dorsal spinal cord vanished [Figure 1]g, [Figure 1]h, [Figure 1]i.

Figure 1: Spine images of MRI. (a–c) The long T1 and T2 signals in the posterior cervical spinal cord in sagittal view and the inverted V-shaped sign in axial view (arrows). (d–f) The long T1 and T2 signals in the posterior thoracic and lumbar regions (arrows). (g–i) Normal spinal cord signal both in sagittal and axial views after treatment. MRI = magnetic resonance imaging

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AIG is a chronic inflammatory gastric mucosa disease that precedes corpus atrophy onset by 10–20 years.[1] The neurological symptoms of SCD usually progress slowly in AIG.[2],[3] But our patient developed severe neurological symptoms 2 weeks after the vaccination, which indicates vaccinations might be a trigger to develop SCD or a post-vaccine spine cord demyelination in our patient. AIG is characterized by anti-parietal cell antibodies produced by the activation of B cells by T cells.[1] Meanwhile, higher frequencies of spike-specific CD8+/CD4+ T cells can be detected after the coronavirus vaccination injection.[4] Due to the ability of T cells to trigger immune-mediated destruction, we believe that coronavirus vaccines may be able to help during the rapid onset of some diseases and might play a role in activating or favoring the autoimmune process in SCD, which is still uncertain and needs further basic experiments to prove it. This is the first case wherein the relationship between SCD with AIG and the COVID-19 vaccines has been discussed. Also, we should consider the possibility of a side effect from coronavirus vaccines when treating SCD with AIG.

Acknowledgements

P J-C, ZM, Z S-H, L K-F, and LJ treated the patient. Z S-H was responsible for the acquisition and interpretation of neuroradiologic imaging. ZM was responsible for histological examinations and analyses. P J-C and LJ wrote the manuscript. All authors were involved in the research and interpretation of findings. They contributed to important intellectual content and wrote and approved the final manuscript.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

2021 Anhui University excellent top talent cultivation subsidy project (grant number: gxgwfx 2021029), Anhui University Science Research Project (grant number: KJ2021A058), clinical research project of the Anhui University of Traditional Chinese Medicine (grant number: 2021yfylc06), the Outstanding Young Talents Project of Universities in Anhui Province Study Abroad (grant number: gxgwfx 2021028), National Key R and D Program of China (grant number: 2018YFC1312001), Anhui key R and D plan (grant number: 2022e07020025), and Anhui Provincial Health Research Project (grant number: AHWJ2022b015).

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Lenti MV, Rugge M, Lahner E, Miceli E, Toh BH, Genta RM, et al. Autoimmune gastritis. Nat Rev Dis Primers 2020;6:56.  
    2.Yu Z, Wang A, Hu C, Yu T, Chen J. Type-1 grade 2 multi-focal gastric neuroendocrine tumors secondary to chronic autoimmune gastritis. Front Med 2022;9:856125.  
    3.Sun Z, Yu X. A case report: Subacute combined degeneration of the spinal cord and pernicious anemia caused by autoimmune gastritis. Medicine (Baltimore) 2022;101:e29226.  
    4.Oberhardt V, Luxenburger H, Kemming J, Schulien I, Ciminski K, Giese S, et al. Rapid and stable mobilization of CD8+ T cells by SARS-CoV-2 mRNA vaccine. Nature 2021;597:268-73.  
    
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