Anti-NMDAR Encephalitis and Myasthenia Gravis Post-COVID-19 Vaccination: Cases of Possible COVID-19 Vaccination-Associated Autoimmunity

Astra Dea Simanungkalit; Vivien Puspitasari; Jacqueline Tasha Margono; Pamela Tiffani; Reza Stevano

doi:10.3889/oamjms.2022.10632

Authors

Astra Dea Simanungkalit Department of Neurology, Siloam Hospitals Lippo Village, Tangerang, Indonesia https://orcid.org/0000-0002-7314-772X
Vivien Puspitasari Department of Neurology, Siloam Hospitals Lippo Village, Tangerang, Indonesia https://orcid.org/0000-0002-3904-249X
Jacqueline Tasha Margono Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia https://orcid.org/0000-0002-8366-4309
Pamela Tiffani Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
Reza Stevano Department of Neurology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia https://orcid.org/0000-0001-8210-5372

DOI:

https://doi.org/10.3889/oamjms.2022.10632

Keywords:

Anti-NMDAR encephalitis, Myasthenia gravis, COVID-19, Vaccination, Case report

Abstract

Abstract

BACKGROUND: Coronavirus disease 2019 (COVID‐19) continues to be a global issue. While immunizations comprise an important line of defense against it, adverse effects may occur. We report two cases of autoimmune conditions affecting the nervous system, anti-N-Methyl-D-Aspartate-receptor (NMDAR) encephalitis and myasthenia gravis (MG), that developed in close association following COVID-19 vaccination.

CASE REPORT: In our first case, a 29-year-old woman presents with recurrent seizures, auditory hallucinations, psychiatric symptoms, and autonomic abnormalities, with an onset of one day after receiving the second dose of inactivated SARS-COV-2 whole virus vaccine. CSF analysis and electroencephalogram (EEG) was consistent with anti-NMDAR encephalitis. In our second case, a 23-year-old woman presents with ocular ptosis, diplopia, hoarseness, and fatigability, which first appeared one-day after her first dose of inactivated SARS-COV-2 whole virus vaccine. Electromyography (EMG) results established a definitive diagnosis of MG.

CONCLUSION: To our knowledge, this is the first report of anti-NMDAR encephalitis and MG associated with inactivated SARS-COV-2 whole virus vaccine. In both cases, COVID-19 vaccination appears to be the only remarkable feature of history. The authors postulate that COVID-19 vaccination may trigger underlying defects or induce failure of positive and negative selection, which may lead to autoreactivity and subsequent autoimmunity. However, further studies are required to confirm this possibility.

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