Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

• Main Authors: Chou, J. (Author), Larovere, K.L (Author), Newburger, J.W (Author), Nigrovic, L.E (Author), Novak, T. (Author), Poussaint, T.Y (Author), Randolph, A.G (Author)
• Format: Article
• Language: English
• Published: MDPI 2022
• Subjects: acute brain disease; alanine aminotransferase; amoxicillin; antibody titer; apparent diffusion coefficient; Article; aspartate aminotransferase; C reactive protein; case report; cerebrospinal fluid; chemiluminescence immunoassay; child; clinical article; comirnaty; corpus callosum; COVID-19 mRNA vaccine; Cytotoxic lesion of the corpus callosum; D dimer; diarrhea; enzyme immunoassay; erythema chronicum migrans; erythrocyte sedimentation rate; glucose; headache; human; hyponatremia; interleukin 2 receptor alpha; Lyme disease; lymphocytopenia; male; Multisystem inflammatory syndrome in children; myocarditis; neutrophilia; nuclear magnetic resonance imaging; pediatric intensive care unit; pediatric multisystem inflammatory syndrome; platelet count; protein cerebrospinal fluid level; prothrombin time; school child; Severe acute respiratory syndrome coronavirus 2; troponin; troponin T; vaccination; visual hallucination; vomiting
• Online Access: View Fulltext in Publisher

 A 12-year-old male was presented to the hospital with acute encephalopathy, headache, vomiting, diarrhea, and elevated troponin after recent COVID-19 vaccination. Two days prior to admission and before symptom onset, he received the second dose of the Pfizer-BioNTech COVID-19 vaccine. Symptoms developed within 24 h with worsening neurologic symptoms, necessitating admission to the pediatric intensive care unit. Brain magnetic resonance imaging within 16 h of admission revealed a cytotoxic splenial lesion of the corpus callosum (CLOCC). Nineteen days prior to admission, he developed erythema migrans, and completed an amoxicillin treatment course for clinical Lyme disease. However, Lyme antibody titers were negative on admission and nine days later, making active Lyme disease an unlikely explanation for his presentation to hospital. An extensive workup for other etiologies on cerebrospinal fluid and blood samples was negative, including infectious and autoimmune causes and known immune deficiencies. Three weeks after hospital discharge, all of his symptoms had dissipated, and he had a normal neurologic exam. Our report highlights a potential role of mRNA vaccine-induced immunity leading to MIS-C-like symptoms with cardiac involvement and a CLOCC in a recently vaccinated child and the complexity of establishing a causal association with vaccination. The child recovered without receipt of immune modulatory treatment. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.