Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : OD09 - OD11 Full Version

SARS-CoV-2 Vaccination Associated Transverse Myelitis: A Case Report


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58310.16916
Bhargavi Kumar, Saravanan Thangavelu, Sakthivel Selvam, Vikranth Raja, Aditya Chandran

1. Associate Professor, Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. 2. Professor and Head, Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. 3. Student CRRI, Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. 4. Student CRRI, Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. 5. Student CRRI, Department of Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

Correspondence Address :
Bhargavi Kumar,
G 802,Purva Amaiti, Trichy Road, Singanallur, Cimbatore-641005, Tamil Nadu, India.
E-mail: kmcbhargavi@gmail.com

Abstract

While policy makers around the globe have meticulously organised mass immunisation against Coronavirus Disease 2019 (COVID-19), its safety concerns and adverse events that need prompt evaluation are also emerging. Acute Transverse Myelitis (TM) is a rare neurological phenomenon where motor, sensory or autonomic disturbance occurs as a result of spinal cord injury. The aetiology of transverse myelitis is thought to be immune-mediated as a result of infection, parainfectious disorder, autoimmune disease or malignancy. Though a rare disease, acute TM warrants prompt recognition and aggressive therapy for favourable neurological patient outcomes. Hereby, authors presented this case of a 61-year-old male patient who developed symptoms of acute TM, 20 days after receiving an adenovirus vectored ChAdOx1 nCoV-19 vaccine against SARS-CoV-2. The patient was treated with intravenous steroids, supportive care with Foley’s catheterisation and his weakness and bladder control improved over 1 week.

Keywords

Adverse reactions, Coronavirus, Immunisation, Severe acute respiratory syndrome coronavirus 2

Case Report

A 61-year-old male presented to the Medicine Department with complaints of constipation and urinary retention for three to four days accompanied by bilateral lower limb weakness. He had a past medical history of seizures 20 years ago and haemorrhagic cerebrovascular accident but was not on any regular medications. The patient had received the first dose of Coronavirus Disease 2019 (COVID-19) vaccine (ChAdOx1 nCoV-19) 20 days prior. His family history was unremarkable for muscular disorders, multiple sclerosis, stroke or any rheumatological disorders.

On physical examination, his heart rate was 72 beats per minute, respiratory rate of 15 breaths per minute, blood pressure was 130/80 mmHg, temperature of 98.4o Fahrenheit, and oxygen saturation of 99% on room air. He was conscious, oriented to time, place, person and did not have neck stiffness or signs of meningeal irritation.

On neurological examination, higher mental functions and cranial nerve examination was normal. He had asymmetrical paresis in lower limbs- power of 0 in the toes, 2 across the ankle joint, power 4 in the left knee, 3 in the right knee and power 3 in the hip joint. Deep tendon reflexes were absent in both the lower limbs and bilateral plantar response was mute. Sensory examination (fine touch, temperature, position sense, joint sense and vibration) was normal. Neurological examination of the upper limbs was within normal limits. Other systemic examination was unremarkable.

Initial laboratory analysis showed a normal complete metabolic profile, complete blood count, and a negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) nucleic acid amplification test. Echocardiography, ultrasonography abdomen was normal and Electroencephalography (EEG) showed no epileptiform discharges. Visual Evoked Potentials (VEP) for both eyes revealed bilateral optic neuritis. Antinuclear Antibody (ANA) profile was negative. The patient underwent Magnetic Resonance Imaging (MRI) of brain and spinal cord which was suggestive of acute demyelination (Table/Fig 1), (Table/Fig 2). Lumbar puncture was performed and Cerebrospinal Fluid (CSF) analysis was done (Table/Fig 3).

Based on the investigations and clinical findings, a diagnosis of postvaccination- longitudinally extensive transverse myelitis was made. The patient was started on injection methylprednisolone at a dose of 1 g/day for 5 days. He was catheterised and given antiepileptics, laxatives, antipyretics and supportive care along with regular physiotherapy. The patient’s symptoms of constipation, urinary retention, and weakness resolved over the next 1 week. The urinary catheter was removed and he was discharged home after 12 days of admission. Two weeks later, patient was followed-up in the Outpatient Department (OPD) and he was able to walk without support.

Discussion

The world is still combatting SARS-CoV-2. Many vaccines were given emergency approval after phase 3 trials. Intensive and mass Immunisation programs are being organised for vaccination and notable reduction in disease severity is noted. Nevertheless, adverse reactions post vaccinations were reported raising safety concerns adding to the vaccine hesitancy. According to the vaccine adverse event reporting system (VAERS), 51,755,447 doses of various COVID-19 vaccines have been administered in the United States until March 2, 2021 of which 9,442 adverse reactions were reported (1). According to the Ministry of Health and Family Welfare, India has reported at least 70,102 cases of Adverse Events Following Immunisation (AEFI), and 1,013 deaths following the COVID-19 vaccines. Of this, Covishield contributed to 90.3% of the total adverse events and to 91% of the vaccine related mortality as of 30th January 2022 (2).

Neurological complications are already recognised rare adverse effects seen in certain vaccines namely diphtheria pertussis tetanus, measles mumps rubella, influenza and hepatitis B vaccines (3). The vaccines against SARS-CoV-2 are either adenovirus vector based (ChAdOx1nCoV-19),m-RNA based (BNT162b2), protein based or inactivated virus based vaccines. All of these act by inciting an immune reaction against COVID-19 and include an antigen, a delivery system and an adjuvant. Vaccine associated adverse events may be attributable to any of these components. COVID-19 vaccine associated neurological complications that were reported worldwide include demyelinating disorders, cortical venous thrombosis, encephalopathy, stroke, seizures, myasthenic syndromes, Guillain-Barré syndrome and Bell’s palsy (4).

Transverse Myelitis (TM) is a rare, acquired focal inflammatory disorder of one or more spinal cord sections (5). The common etiologies are demyelinating illness such as multiple sclerosis, neuromyelitis optica, infections, autoimmune diseases ,malignancies, paraneoplastic and rarely vaccines. The commonly associated infections are cytomegalovirus, varicella-zoster virus, Epstein barr virus, and coxsackieviruses (6). The incidence of COVID-19-related transverse myelitis has been reported as 0.5 case/per million people, roughly 1.2% of all COVID-19 related neurological complications (7). The incidence of acute TM is estimated to be up to 3-5 cases per million people a year and vaccine-associated events are rarer (8). Transverse myelitis could result due to acute or subacute dysfunction of the spinal cord and could be complete or partial as well. In the index patient, MRI showed long segment T2 hyperintense signal changes in the spinal cord from D9-L1 level. The incidence of acute TM varies between 1-8 million per year and peaks between 2nd-4th decades (9). The index patient on the contrary is in the 7th decade of his life.

In a literature review of 39 articles discussing Central Nervous System (CNS) adverse effects of COVID-19 vaccines, five patients had developed transverse myelitis post vaccination (4). However, all occurred within 4 days after vaccination contrary to the present case where the day of onset of symptoms was 20 days postvaccination.

According to the Vaccine Adverse Event Reporting System (VAERS), nine cases of acute transverse myelitis (incidence is approximately 1.739/per million people) were reported among the total 9442 adverse events following COVID-19 vaccines in the United States as of March 2021 (10). Indeed a total of 119 postvaccination Acute Transverse Myelitis (ATM) cases were reported during the period from 1985 to 2017 (1). Other than nine cases, neurological complications contributed to 2.69% of the total Adverse Events Following Immunization (AEFI) following Pfizer-BioNTech, Moderna, and Johnson & Johnson’s (10). So also, two serious events of transverse myelitis were noted following recombinant ChAdOx1 nCoV-19 vaccine (11),(12).

Initially acute transverse myelitis was reported following viral vector vaccines and it was assumed that the viruses used for vaccination can induce autoimmunity, exhibit molecular mimicry, or have epitopes similar to the virus itself (1). Nevertheless, in the mRNA vaccines, autoimmune interactions are probably though to occur between the Angiotensin Converting Enzyme-2 (ACE-2) receptors in the body and the virus spike protein antibody per se. Also, it was proposed that thrombogenic state induced by vaccination can cause spinal cord infarction leading to transverse myelitis (13). Agmon-Levin N et al., proposed that post vaccination transverse myelitis may be the resultant of autoimmune reaction attributed to molecular similarity, accentuation of pre-existing autoimmune process or B lymphocytes’ poly clonal activation leading to a cytokine storm (5).

A large population-based study of more than 32 million people done in the United Kingdom investigated the neurological adverse events associated with the ChAdOx1 nCoV-19 and BNT162b2 vaccines as well as SARS-CoV-2 infection (14). It was found that increased risk of hospital admission was present for Guillain-Barré syndrome, Bell’s palsy and myasthenic disorders in those who received the ChAdOx1 nCoV-19 vaccine. Increased risk of hospital admission for hemorrhagic stroke was observed in those who received the BNT162b2 vaccine. More importantly the risk of neurological outcomes following a positive SARS-CoV-2 test, such as acute CNS demyelinating events, encephalitis meningitis and myelitis, Guillain-Barré syndrome, Bell’s palsy, myasthenic disorders, haemorrhagic stroke and subarachnoid haemorrhagic was documented. A crucial finding in this study was that the risk of neurological infections was far higher by the infection itself in comparison with the few events associated with the vaccine. This strongly advocates the need for vaccination rather than a vaccine reluctance.

Currently, there are no standard guidelines to treat post vaccination transverse myelitis. Conventionally transverse myelitis is managed with intravenous steroids as the first line therapy. Plasma exchange is done in steroid refractory cases (15). Other immunomodulatory therapies include cyclophosphamide and rituximab. The index patient was treated with intravenous steroids for 5 days and showed significant improvement in his neurological symptoms.

Conclusion

Any new disease comes with lot of challenges and new vaccines are to be closely monitored. Adverse events reporting system is not to sideline the vaccine importance or size down mass vaccination campaigns, rather only to add new data and share knowledge to raise global awareness. A causal link has not been conclusively established with the vaccine and side-effects except for the temporal association. The shared pathophysiological mechanism between the virus and vaccines may be central to the development of the adverse events. First contact physicians should be aware of acute TM after COVID-19 vaccination and maintain a high index of suspicion in patients presenting with neurological deficits after receiving the vaccine.

References

1.
Shah S, Patel J, Alchaki AR, Eddin MF, Souayah N. Development of transverse myelitis after vaccination, A CDC/FDA vaccine adverse event reporting system (VAERS) study, 1985-2017. Neurology. 2018;90(Suppl. 15):5.099.
2.
The National AEFI Committee. Ministry of Health and Family welfare. Press release:4 February 2022. 70,102 adverse events after vaccination reported in India: Govt data - BusinessToday . https://main.mohfw.gov.in/Organisation/Departments-of-Health-and-Family-Welfare/immunization/aefi-reports.
3.
DeStefano F, Verstraeten T, Jackson LA, Okoro CA, Benson P, Black SB, et al. Vaccinations and risk of central nervous system demyelinating diseases in adults. Arch Neurol. 2003;60(4):504-09. Doi:10.1001/archneur.60.4.504. [crossref] [PubMed]
4.
Srivastava S, Sharma K, Khalid SH, Bhansali S, Shrestha AK, Elkhooly M, et al. COVID-19 vaccination and neurological manifestations: A review of case reports and case series. Brain Sci. 2022;12(3):407. Doi.org/10.3390/brainsci12030407. [crossref] [PubMed]
5.
Agmon-Levin N, Kivity S, Szyper-Kravitz M, Shoenfeld Y. Transverse myelitis and vaccines: A multi-analysis. Lupus. 2009;18(13):1198-204. Doi: 10.1177/0961203309345730. [crossref] [PubMed]
6.
Khan E, Shrestha AK, Colantonio MA, Liberio RN, Sriwastava S. Acute transverse myelitis following SARS-CoV-2 vaccination: A case report and review of literature. J Neurol. 2022;269(3):1121-32. Doi: 10.1007/s00415-021-10785-2. [crossref] [PubMed]
7.
Roman GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute Transverse Myelitis (ATM): Clinical review of 43 patients with COVID-19-associated ATM and 3 post-vaccination ATM serious adverse events with the ChAdOx1 nCoV-19 vaccine (AZD1222) front. Immunol. 2021;12:653786. Doi: 10.3389/fimmu.2021.653786. [crossref] [PubMed]
8.
Hsiao YT, Tsai MJ, Chen YH, Hsu CF. Acute transverse myelitis after COVID-19 vaccination. Medicina (Kaunas). 2021;57(10):1010. Doi: 10.3390/medicina57101010. [crossref] [PubMed]
9.
Tahir N, Koorapati G, Prasad S, Jeelani HM, Sherchan R, Shrestha J, et al. SARS-CoV-2 vaccination-induced transverse myelitis. Cureus. 2021;13(7):e16624. Doi: 10.7759/cureus.16624. PMID: 34458035. [crossref]
10.
Goss AL, Samudralwar RD, Das RR, Nath A. ANA investigates: neurological complications of COVID-19 vaccines. Ann Neurol. 2021;89(5):856-57. Doi: 10.1002/ana.26065. [crossref] [PubMed]
11.
Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Oxford COVID Vaccine Trial Group. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: An interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99-111. [crossref]
12.
Knoll MD, Wonodi C. Oxford-AstraZeneca COVID-19 vaccine efficacy. Lancet. 2021;397(10269):72-74. Doi: 10.1016/S0140-6736(20)32623-4. [crossref]
13.
Vojdani A, Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin Immunol. 2020;217:108480. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/58310.16916

Date of Submission: Jun 07, 2022
Date of Peer Review: Jul 07, 2022
Date of Acceptance: Jul 23, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 16, 2022
• Manual Googling: Jul 16, 2022
• iThenticate Software: Aug 23, 2022 (13%)

ETYMOLOGY: Author Origin

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