Brown-Séquard syndrome in a patient with spondyloarthritis after COVID-19 vaccine: a challenging differential diagnosis
Authors
Rafaela Costa; Carolina Soares; Carlos Vaz; Miguel Bernardes; Margarida Tavares; Pedro Abreu;
Keywords
A 41-year-old woman with pre-radiographic axial and peripheric spondyloarthritis, taking adalimumab since 2010, started motor impairment of the right limbs and numbness of the left leg seven days after the administration of COVID-19 mRNA vaccine. Adalimumab was taken 47 days before clinical onset. A comprehensive study for infectious, autoimmune and neoplastic causes were unremarkable. MRI depicted an acute inflammatory lesion at C2 level with gadolinium enhancement. The patient started methylprednisolone with clinical improvement. Three scenarios should be considered: primary CNS inflammatory disorder or a secondary manifestation of the underlying rheumatologic disease; immune-mediated inflammatory lesion triggered by vaccine; demyelinating event due to adalimumab.
Rafaela Costa
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
Carolina Soares
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
Carlos Vaz
Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine/Rheumatology, Faculty of Medicine of University of Porto, Porto, Portugal
Miguel Bernardes
Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine/Rheumatology, Faculty of Medicine of University of Porto, Porto, Portugal
Margarida Tavares
Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal; EPI Unit - Instituto de Saúde Pública, University of Porto, Porto, Portugal
Pedro Abreu
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
Carolina Soares
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
Carlos Vaz
Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine/Rheumatology, Faculty of Medicine of University of Porto, Porto, Portugal
Miguel Bernardes
Department of Rheumatology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Medicine/Rheumatology, Faculty of Medicine of University of Porto, Porto, Portugal
Margarida Tavares
Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal; EPI Unit - Instituto de Saúde Pública, University of Porto, Porto, Portugal
Pedro Abreu
Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal