MOGAD presents with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, aseptic meningoencephalitis, or pseudotumor cerebri-like presentations?[4]. MOGAD has been reported with coronavirus disease 2019 (COVID-19) like a em virtude de- or post-infection [5-8]. be considered along with thrombosis with thrombocytopenia syndrome. strong class=”kwd-title” Keywords: myelin oligodendrocyte glycoprotein-associated disorders, post-chadox1 vaccination mogad, post-vaccination mogad, chadox1?vaccination, mogad Intro The ChAdOx1 nCoV-19 vaccine is associated with very rare adverse events following immunization (AEFI), such as thrombosis with thrombocytopenia syndrome, inflammatory myositis, and autoimmune encephalitis?[1-3]. Myelin oligodendrocyte glycoprotein-associated disorders (MOGAD) is an inflammatory demyelinating disorder associated with immunoglobulin G (IgG) serum?MOG?antibodies. MOGAD presents with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, aseptic meningoencephalitis, or pseudotumor cerebri-like presentations?[4]. MOGAD has been reported D-106669 with coronavirus disease 2019 (COVID-19) like a em virtude de- or post-infection [5-8]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness is thought to elicit a host autoimmune response that precipitates MOGAD. However, post-vaccine MOGAD (PV-MOGAD) after COVID-19 vaccination has not yet been explained. Here, we describe three instances of PV-MOGAD after the ChAdOx1 vaccination. Case demonstration Case 1 A 43-year-old female received her 1st dose of the ChAdOx1?vaccination. Six days later, she started developing severe bifrontal headaches and photophobia. On admission, 15 days later, she was mentioned to have terminal neck tightness and grade I papilledema. Cerebrospinal fluid (CSF) exam was normal. Antinuclear antibody (ANA) profile and routine workup were bad. Magnetic resonance imaging (MRI) of the brain showed scattered areas of sulcal and leptomeningeal enhancement in the frontotemporal areas. Her serum COVID-19 anti-spike antibody was strongly positive. She was treated with steroids (intravenous (IV) dexamethasone 4 mg BD for seven days) and antibiotics (ceftriaxone) having a presumptive analysis of aseptic meningitis. When her headaches improved after a week she was discharged. One week later on, she presented with a worsening headache. This time MRI of the brain showed a right temporal heterogeneously enhancing lesion with mass effect for which underwent a right temporal craniotomy and excision.?Bacterial and fungal cultures did not show any growth. Histopathology showed cores of neuroparenchyma with dense interstitial and perivascular infiltrates of macrophages and foamy histiocytes admixed with lymphocytes. Myelin (Luxol fast blue) staining highlighted demyelinated areas with macrophages showing cytoplasmic myelin debris. The features were consistent with tumefactive demyelination. At this point, serum was highly positive for MOG IgG antibody by indirect immunofluorescence on transfected cells. Two weeks MYH9 later, her headache recurred and she was started on IV methylprednisolone 1 g/day time for three days and two doses of rituximab 1 g IV one month apart. She remained asymptomatic in the two-month follow-up. A repeat serum MOG IgG was moderately positive. Case 2 A 26-year-old female developed a severe headache 10 days after her 1st dose of the ChAdOx1?vaccination (Visual Analog Level (VAS) score, 8/10). She was treated symptomatically and referred to neurology after two months when she developed limb paraesthesia and sequentially decreased vision in both eyes over two weeks. MRI of the brain showed bilateral optic neuritis. CSF exam showed 25 cells, all lymphocytes with normal protein and sugars, and oligoclonal bands. MOG IgG antibody was strongly positive. She was started on IV methylprednisolone 1 g/day time for five days, followed by oral prednisolone 40 mg and mycophenolate 1 g/day time. Her headaches disappeared, and steroids were tapered five weeks later on. Two weeks after steroids were stopped, she presented with severe headaches (VAS, 9/10) and vomiting. MRI of the brain and spine were normal; however, a repeat CSF study showed 85 cells with 58% lymphocytes, normal protein, and glucose. A CSF meningoencephalitis panel, neuronal antibody panel, D-106669 ANA, and antineutrophil cytoplasmic antibodies were negative. MOG IgG antibody was again strongly positive. She was started on IVIg 2 g/kg over five days and IV methylprednisolone 1 g/kg for five days. As she had persistent severe headaches for two weeks, she was administered rituximab 1 g. Her headache disappeared by week four. She was discharged on oral prednisolone 40 mg/day and mycophenolate 1 g/day. Rituximab 1 g was readministered at one month. A final diagnosis of recurrent PV-MOGAD meningitis was made. Case 3 A 20-year-old woman developed severe right-sided headache, right ear pain, and neck pain the day after her second dose of the ChAdOx1?vaccination. On day three, she presented with fever, right hemiparesis, dysarthria, and right-sided numbness. She was discharged when an outside MRI of the brain with magnetic resonance angiography was normal. Five days later, she D-106669 was admitted to our hospital when she.
