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Acute encephalitis, myoclonus and Sweet syndrome after mRNA-1273 vaccine
  1. Gabriel Torrealba-Acosta1,
  2. Jennifer C Martin2,
  3. Yve Huttenbach3,
  4. Catherine R Garcia1,
  5. Muhammad R Sohail4,
  6. Sandeep Krishna Agarwal5,
  7. Carina Wasko2,
  8. Eric M Bershad1 and
  9. Mohammad I Hirzallah1
  1. 1Neurology, Baylor College of Medicine, Houston, Texas, USA
  2. 2Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
  3. 3Department of Dermatopathology, Baylor College of Medicine, Houston, Texas, USA
  4. 4Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
  5. 5Department of Medicine, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Gabriel Torrealba-Acosta; gabriel.torrealbaacosta{at}bcm.edu

Abstract

A patient presented with fever, generalised rash, confusion, orofacial movements and myoclonus after receiving the first dose of mRNA-1273 vaccine from Moderna. MRI was unremarkable while cerebrospinal fluid showed leucocytosis with lymphocyte predominance and hyperproteinorrachia. The skin evidenced red, non-scaly, oedematous papules coalescing into plaques with scattered non-follicular pustules. Skin biopsy was consistent with a neutrophilic dermatosis. The patient fulfilled the criteria for Sweet syndrome. A thorough evaluation ruled out alternative infectious, autoimmune or malignant aetiologies, and all manifestations resolved with glucocorticoids. While we cannot prove causality, there was a temporal correlation between the vaccination and the clinical findings.

  • COVID-19
  • dermatology
  • vaccination/immunisation
  • neurology
  • unwanted effects / adverse reactions

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Footnotes

  • Twitter @DrGabrielNeuro

  • Contributors All authors have contributed to the work and agree with the presented findings and that the work has not been published before nor is being considered for publication in another journal. GT-A, CRG, EMB and MIH conceptualised the report and made substantial contributions to the design, drafting and critical revision of the neurological aspects of this work. These authors approved the final version of the manuscript and assume accountability for all aspects of the work. JCM, YH and CW conceptualised the report and made substantial contributions to the design, drafting and critical revision of the dermatological aspects of this work. These authors approved the final version of the manuscript and assume accountability for all aspects of the work. MRS and SKA conceptualised the report and made substantial contributions to the design, drafting and critical revision of the infectious and immunological aspects of this work. These authors approved the final version of the manuscript and assume accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.