COVID-19 Vaccination Autoimmune Spastic Adverse Event Following Immunization (AEFI) in a Pediatric Patient

Background: Since coronavirus (COVID-19) pandemic in 2019 health researchers worldwide have been trying to investigate clinical complications of the virus, furthermore the vaccine complications and adverse effects.

Neurological (Adverse Event Following Immunization) AEFI may range from facial palsy to stroke, while the most common neurological symptoms included dizziness, headache, pain, muscle spasm, myalgia and paresthesia.

To our knowledge, there are no reported cases about COVID-19 vaccination neurological spastic AEFI suggesting acute transverse myelitis as a differential diagnosis, without a significant MRI or laboratory findings rising questions about the accurate diagnosis.

Case report: A 14-years old male, previously healthy, without underlying clinical conditions or chronic medication usage, vaccinated as recommended for his age without any previous AEFI. Presented with high fever ,chills, bi-frontal headaches and rhythmic movements of the head, started 24 hours after receiving the COVID-19 vaccine. On the next day, he developed a gait abnormality. on examination, gait was spastic and instable with pathological tandem gait, a sensory impairment approximately at D7-8 level, with no urinary symptoms. MRI of brain and whole spine did not show any pathology, Lumbar tap showed no pleocytosis with slightly increased protein level.

In consideration of neurological autoimmune AEFI we started treatment of Methylprednisolone. A very impressive clinical response was observed 24 hours after initiation of steroidal therapy, three days later, a full recovery was observed.

Conclusion: Spastic and instable gait is probably neurological adverse event of COVID-19 vaccination. This can be explaiened by the impressive recovery under steroids therapy, confirming an immune mechanism.