1. Glial fibrillary acidic protein astrocytopathy in a patient with recent mRNA SARS-CoV-2 vaccination
- Author
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Koh, Pei Xuan, Tay, Kay Yaw, Yeo, Tianrong, Singh, Dinesh Rambachan, Koh, Jasmine Shimin, Thirugnanam, Umapathi N, and Saini, Monica
- Subjects
Glial fibrillary acidic protein astrocytopathy ,mmol, millimoles ,MRI, Magnetic resonance imaging ,ALT, alanine transaminase ,TB, tuberculosis ,WBC, white blood cells ,L, litre ,Ag, antigen ,RSV, Respiratory Syncytial Virus ,U, units ,macromolecular substances ,Ab, antibody ,Article ,myelitis ,HbA1c, glycosylated haemoglobin ,DNA, deoxyribonucleic acid ,AST, aspartate transaminase ,ng, Nano gram ,C, Chlamydia ,PCR, Polymerase Chain Reaction ,GAD, glutamic acid decarboxylase ,meningoencephalitis ,CT, Computed Tomography ,umol, micromoles ,Ig, immunoglobulin ,HIV, human immunodeficiency virus ,mRNA SARS-CoV-2 vaccine ,nervous system ,RT, Reverse Transcriptase ,ANA, antinuclear antibody ,M, mycoplasma ,B, Bacillus ,u, micro ,ds, double stranded - Abstract
Background Literature describing triggers of GFAP astrocytopathy (GFAP-A) is limited. We report a case of GFAP-A in a patient with recent messenger ribonucleic acid (mRNA) severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination and discuss the possible pathogenesis. Case description A 45-year-old gentleman presented with features of meningoencephalitis 31 days after the first dose and 4 days after the second dose of mRNA SARS-CoV-2 vaccination. He sequentially developed brainstem/cerebellar, autonomic and cord dysfunction. Cerebrospinal fluid was positive for GFAP autoantibody. Clinical improvement occurred after intravenous methylprednisolone and immunoglobulins. Conclusion Although we are uncertain of a causal link of GFAP-A to mRNA vaccine, indirect activation of an underlying dysregulated immune milieu is plausible.
- Published
- 2022