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NEUROMYELITIS OPTICA POST-VACCINATION OF COVID-19 IN PEDIATRICS: A CASE REPORT
Apresentação do caso
Case presentation: S.V.S, female, 14 years old, reports that in December 2021, 7 days after being vaccinated for Covid-19 (Pfizer), she developed axial and lower limb weakness, progressing to paraplegia, in addition to altered sensitivity, pain in the cervical, visual disturbs and sphincter dysfunction. In the liquor, she presented serologies for Toxoplasmosis, Cysticercosis, Schistosomiasis, HTLV I and II, VDRL, FTA ABS negatives and Aquaporin reagent antibody. The MRI of the skull revealed bilateral and symmetrical frontotemporoparietoinsular white matter signal alteration and the MRI of the spine revealed thickening and signal alteration in the central portion of the cervicodorsal spinal cord, C3-D10, suggesting inflammatory nature (myelitis). Given the clinical picture and findings in complementary exams, the diagnosis of Neuromyelitis optica was made, treating initially with pulse therapy for 5 days, followed by the administration of azathioprine, medication with which the patient had an allergic reaction, being replaced by rituximab.
Discussion: Faced with the high transmissibility of the Sars-Cov-2 virus, scientists have joined forces to create a vaccine against the pathogen to contain the progression of the disease. Following the mass vaccination protocols, there has been an increase in reports of inflammatory CNS diseases, which are considered rare especially in the pediatric group. In this context, Neuromyelitis optica (NMO) is an autoimmune demyelinating disease that damage the optic nerves and spinal cord with the prevalence of 0.5 to 1/105 mainly at females. With that said, the average interval between neurological complications after vaccination varies according to the type of pathogen inoculated.
Final comments: Vaccination comprises a series of important actions to stop mass contamination of the population. However, it is essential to clarify the possible side effects of immunization administration, such as demyelinating and autoimmune diseases. Therefore, doctors should be aware of the pros and cons of vaccination and should know how to recognize the signs and symptoms as well as the treatment of NMO. Furthermore, as the clinical course of NMO is recurrent, it is important to observe how vaccination works in patients with a definite diagnosis.
Referências (se houver)
Keywords: COVID-19; Neuromyelitis optica; Vaccine; Pfizer; Pediatrics.
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Neuroimunologia, esclerose múltipla e outras doenças desmielinizantes
Escola Bahiana de Medicina e Saúde Pública - Bahia - Brasil, Hospital Martagão Gesteira - Bahia - Brasil
Victoria Faustino Silva Reis, Murilo Lopes Coelho, Samantha Lopes Oliveira, Gabriel Vianna Pereira Aragão, Camilo Vieira Santos