Abstract
Objectives Acute neuronitis secondary to COVID-19 vaccines has been seldom reported, mostly involving the brachial plexus. We present two cases of brachial and lumbosacral plexitis following AstraZeneca (AZ) COVID-19 vaccine in patients on immunotherapy for Multiple Sclerosis (MS).
Methods and Results A 51-year old female with a 12 month history of MS on natalizumab, received the second AZ COVID-19 vaccination in June 2021. The next day she developed left shoulder pain and lower limb weakness. A brachial and lumbosacral plexus MRI demonstrated left brachial plexitis and right sciatic and left femoral neuritis in the lower limbs. She received IV methylprednisolone (MP) and IV immunoglobulins with a poor response prompting change of immunotherapy to ofatumumab.
A 45-years old female with a 21 year history of MS on ocrelizumab, received the second AZ COVID-19 vaccination in June 2021. Soon after the injection she developed right shoulder and arm pain and weakness. A brachial plexus MRI revealed hyperintense T2 increased enhancement of some of the posterior and inferior branches of the right brachial plexus cords. She received two courses of IVMP and oral prednisone tapering with gradual improvement.
Conclusion Brachial and lumbosacral plexitis may occur following AZ COVID-19 vaccination despite previous immunotherapy. To the best of our knowledge, this is the first report of COVID-19 vaccination related plexitis on MS patients on immunotherapy and the second of post COVID-19 vaccine lumbosacral neuritis.
