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Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit

Bickerstaff brainstem encephalitis (BBE) is a rare, immune-mediated disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance. It has a complex multifactorial etiology, and a preceding infectious illness is seen in the majority of cases. Immune-media...

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Autores principales: Monte, Gabriele, Pro, Stefano, Ursitti, Fabiana, Ferilli, Michela Ada Noris, Moavero, Romina, Papetti, Laura, Sforza, Giorgia, Bracaglia, Giorgia, Vigevano, Federico, Palma, Paolo, Valeriani, Massimiliano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411636/
https://www.ncbi.nlm.nih.gov/pubmed/36032138
http://dx.doi.org/10.3389/fimmu.2022.987968
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author Monte, Gabriele
Pro, Stefano
Ursitti, Fabiana
Ferilli, Michela Ada Noris
Moavero, Romina
Papetti, Laura
Sforza, Giorgia
Bracaglia, Giorgia
Vigevano, Federico
Palma, Paolo
Valeriani, Massimiliano
author_facet Monte, Gabriele
Pro, Stefano
Ursitti, Fabiana
Ferilli, Michela Ada Noris
Moavero, Romina
Papetti, Laura
Sforza, Giorgia
Bracaglia, Giorgia
Vigevano, Federico
Palma, Paolo
Valeriani, Massimiliano
author_sort Monte, Gabriele
collection PubMed
description Bickerstaff brainstem encephalitis (BBE) is a rare, immune-mediated disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance. It has a complex multifactorial etiology, and a preceding infectious illness is seen in the majority of cases. Immune-mediated neurological syndromes following COVID-19 vaccination have been increasingly described. Here we report the case of a child developing BBE 2 weeks after COVID-19 vaccination. Despite nerve conduction studies and CSF analysis showing normal results, BBE was diagnosed on clinical ground and immunotherapy was started early with a complete recovery. Later, diagnosis was confirmed by positive anti-GQ1b IgG in serum. Even if there was a close temporal relationship between disease onset and COVID-19 vaccination, our patient also had evidence of a recent Mycoplasma pneumoniae infection that is associated with BBE. Indeed, the similarity between bacterial glycolipids and human myelin glycolipids, including gangliosides, could lead to an aberrantly immune activation against self-antigens (i.e., molecular mimicry). We considered the recent Mycoplasma pneumoniae infection a more plausible explanation of the disease onset. Our case report suggests that suspect cases of side effects related to COVID-19 vaccines need a careful evaluation in order to rule out well-known associated factors before claiming for a causal relationship.
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spelling pubmed-94116362022-08-27 Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit Monte, Gabriele Pro, Stefano Ursitti, Fabiana Ferilli, Michela Ada Noris Moavero, Romina Papetti, Laura Sforza, Giorgia Bracaglia, Giorgia Vigevano, Federico Palma, Paolo Valeriani, Massimiliano Front Immunol Immunology Bickerstaff brainstem encephalitis (BBE) is a rare, immune-mediated disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance. It has a complex multifactorial etiology, and a preceding infectious illness is seen in the majority of cases. Immune-mediated neurological syndromes following COVID-19 vaccination have been increasingly described. Here we report the case of a child developing BBE 2 weeks after COVID-19 vaccination. Despite nerve conduction studies and CSF analysis showing normal results, BBE was diagnosed on clinical ground and immunotherapy was started early with a complete recovery. Later, diagnosis was confirmed by positive anti-GQ1b IgG in serum. Even if there was a close temporal relationship between disease onset and COVID-19 vaccination, our patient also had evidence of a recent Mycoplasma pneumoniae infection that is associated with BBE. Indeed, the similarity between bacterial glycolipids and human myelin glycolipids, including gangliosides, could lead to an aberrantly immune activation against self-antigens (i.e., molecular mimicry). We considered the recent Mycoplasma pneumoniae infection a more plausible explanation of the disease onset. Our case report suggests that suspect cases of side effects related to COVID-19 vaccines need a careful evaluation in order to rule out well-known associated factors before claiming for a causal relationship. Frontiers Media S.A. 2022-08-12 /pmc/articles/PMC9411636/ /pubmed/36032138 http://dx.doi.org/10.3389/fimmu.2022.987968 Text en Copyright © 2022 Monte, Pro, Ursitti, Ferilli, Moavero, Papetti, Sforza, Bracaglia, Vigevano, Palma and Valeriani https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Monte, Gabriele
Pro, Stefano
Ursitti, Fabiana
Ferilli, Michela Ada Noris
Moavero, Romina
Papetti, Laura
Sforza, Giorgia
Bracaglia, Giorgia
Vigevano, Federico
Palma, Paolo
Valeriani, Massimiliano
Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit
title Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit
title_full Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit
title_fullStr Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit
title_full_unstemmed Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit
title_short Case report: A pediatric case of Bickerstaff brainstem encephalitis after COVID-19 vaccination and Mycoplasma pneumoniae infection: Looking for the culprit
title_sort case report: a pediatric case of bickerstaff brainstem encephalitis after covid-19 vaccination and mycoplasma pneumoniae infection: looking for the culprit
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411636/
https://www.ncbi.nlm.nih.gov/pubmed/36032138
http://dx.doi.org/10.3389/fimmu.2022.987968
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