Following the widespread administration of vaccines, various side effects have been reported. Recent research once again confirms that certain COVID-19 vaccines may trigger neuromyelitis optica, a condition that can result in blindness, paralysis, and even death.
This condition is characterized by its unpredictability and tendency to relapse—each episode leads to increasingly severe disability. While most patients recover partial functionality after an episode, some may experience permanent loss of vision or various neurological symptoms, potentially leading to death.
Onset of Neuromyelitis Optica Following COVID-19 Vaccination
A 70-year-old woman, shortly after receiving the COVID-19 vaccine, developed neuromyelitis optica. This case report, documented by researchers from Isfahan University of Medical Sciences in Iran, was published in the journal Multiple Sclerosis and Related Disorders in 2022.The patient was admitted to the hospital seven days after receiving the third dose of the inactivated COVID-19 vaccine, presenting symptoms that included numbness and weakness in the left limbs. “Her left-sided hypoesthesia and hemiparesis rapidly progressed to paraplegia.” Over the next three days, her upper limb paresis symptoms further deteriorated.
Magnetic resonance imaging (MRI) of the spinal cord revealed hemorrhagic lesions in the cervical and thoracic cord of the patient, with no abnormalities detected in cerebrospinal fluid analysis. Additionally, the patient tested positive for AQP4-Ab antibodies. Based on the criteria of The International Panel for NMO Diagnosis, the diagnosis was confirmed as neuromyelitis optica.
The patient underwent intravenous methylprednisolone therapy for five days but did not exhibit any improvement. Similarly, plasma exchange was performed without success. Subsequently, the patient experienced respiratory insufficiency, and symptoms escalated to quadriplegia. Despite treatment with cyclophosphamide, there was no improvement, and the patient developed fever and lymphopenia. Eventually, the patient succumbed to the illness after two months of hospitalization.
The researchers noted that this rare autoimmune disease typically does not affect individuals above the age of 50. However, this woman developed the condition at the age of 70, and she had no history of demyelinating diseases or other autoimmune-related disorders prior to receiving the vaccine.
The authors of the paper highlighted that the patient developed late-onset neuromyelitis optica seven days after receiving the vaccine, and AQP4-Ab positivity was possibly induced by vaccination. However, it cannot be ruled out that pre-existing asymptomatic AQP4-Ab seropositivity may have been present. Under this assumption, vaccine administration could potentially trigger a neuromyelitis optica relapse, even in elderly individuals.
Association Between Multiple Vaccines and Neuromyelitis Optica
Neuromyelitis optica and multiple sclerosis are complications associated with COVID-19 vaccines, both falling under the category of autoimmune demyelinating diseases of the central nervous system. In June, the University of Maryland published a study where researchers analyzed 41 cases of neuromyelitis optica. This included 15 newly diagnosed cases post-SARS-CoV-2 infection, 21 cases of new-onset following COVID-19 vaccination, 3 cases of relapse following vaccination, and 2 cases initially presumed to be multiple sclerosis but later revealed as neuromyelitis optica post-vaccination. Notably, females accounted for 76 percent of these cases.The researchers conducted a detailed analysis of the clinical manifestations and treatment outcomes in cases of new-onset and relapsed neuromyelitis optica after COVID-19 vaccination. Following COVID-19 vaccination, 26 patients developed newly occurring demyelinating events associated with neuromyelitis optica. Among these, 81 percent were experiencing their initial episode, while 19 percent experienced a recurrent worsening of neuromyelitis optica symptoms after vaccination.
The vaccines administered to the 26 patients included the Pfizer-BioNTech BNT162b2 mRNA vaccine, the Oxford-AstraZeneca ChAdOx1 nCoV-19 viral vector vaccine, the Moderna mRNA-1273 vaccine, the Sinopharm or Sinovac COVID-19 inactivated vaccine, and the Sputnik V adenovirus viral vector vaccine. There was also one case where the vaccine was unspecified but belonged to the viral vector category. Overall, 54 percent of the cases involved mRNA vaccines, 31 percent involved viral vector vaccines, and 15 percent involved inactivated COVID-19 vaccines.
Additionally, when breaking down vaccine doses and symptom onset among the 26 patients, it was found that 58 percent experienced neurological symptoms after receiving the first dose, while 23 percent and 8 percent of patients developed neurological symptoms after the second and third doses, respectively.
In the acute treatment of patients, intravenous methylprednisolone, plasmapheresis (plasma exchange), intravenous immunoglobulin, and maintenance immunotherapy were employed. Most patients experienced partial or complete recovery after treatment, but two patients succumbed to the illness.
The researchers also compared the clinical characteristics of patients developing neuromyelitis optica post-SAR-CoV-2 infection and post-COVID-19 vaccine administration. The conclusion drawn was that the percentage of complications and death rates were similar between the two groups. However, in comparison to the SAR-CoV-2 infection group, the COVID-19 vaccine group was more likely to test positive for AQP4-Ab antibodies, with percentages of 65 percent and 85 percent, respectively. Additionally, the COVID-19 vaccine group had a higher likelihood of developing autoimmune conditions compared to the SAR-CoV-2 infection group, with percentages of 31 percent versus 13 percent.
