https://orcid.org/0000-0002-1574-8682
We thank Finsterer for the letterCitation1 and important points concerning our recent case report, “Longitudinally extensive transverse myelitis after Covid-19 vaccination: case report and review of literature.”Citation2
Regarding the raised concerns over our diagnosis, routine tests, including thyroid function tests (TFT), were performed and were normal. CSF sample was evaluated for infectious agents including Covid, HSV, TB, etc. Brain MRI was performed and was normal, and due to the patient’s good response to corticosteroids both clinically and radiologically, the patient was unlikely to have infectious diseases.
We did not measure interleukins, cytokines, and glial factors in CSF sample as these factors are considered nonspecific and might increase in other causes of myelitis.
In our case, the onset of symptoms was 21 days after vaccination which is considered acceptable as neurological complications have been reported in various studies for up to 4 weeks.Citation3 The patient was referred to our clinic 14 days after the onset of symptoms which was due to her prior visit to another center (where she was not diagnosed).
The number of reported neurological complications following Covid vaccination is not high. Despite the widespread vaccination, there are not as many reported cases of myelitis as expected (16 cases versus 11.29 billion doses). This is partly due to the reporting of patients with severe complications such as: stroke, Guillain Barre syndrome, facial palsy, transverse myelitis, and acute disseminated encephalomyelitis as well.Citation4 Also, the manuscript was drafted in April 2021 and unfortunately was not updated by the time of publication.
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References
- Finsterer J. SARS-CoV-2 vaccinations complicated by transverse myelitis. Human Vaccines & Immunotherapeutics. 2022;1–1. doi:10.1080/21645515.2022.2057162.
- Maroufi SF, Naderi Behdani F, Rezania F, Tanhapour Khotbehsara S, Mirzaasgari Z. Longitudinally extensive transverse myelitis after Covid-19 vaccination: case report and review of literature. Hum Vaccines Immunotherapeutics. 2022;18:2040239.
- Li X, Raventós B, Roel E, Pistillo A, Martinez-Hernandez E, and Delmestri A, et al. Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events: population based cohort and self-controlled case series analysis. BMJ. 2022;376:e068373.
- Tabatabaee S, Rezania F, Alwedaie SMJ, Malekdar E, Badi Z, and Tabatabaei SM, et al. Post COVID-19 vaccination Guillain-Barre syndrome: three cases. Hum Vaccines Immunotherapeutics. 2022;18:1–5.