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• W2415705963 abstract "Dear Editor, RE: TRANSVERSE MYELITIS AFTER MEASLES AND RUBELLA VACCINATION We read with great interest the report on transverse myelitis (TM) after measles and rubella vaccination by Lim et al. published in the October issue of the journal.1 We would like to present two additional cases of TM following vaccination. A previously well 7.5-year-old boy complained of pain in his waist and lower extremities 23 days after a second revaccination with diphtheria–tetanus toxoid (DT) and oral polio vaccine (OPV) on 6 January 1982. Clinical signs were compatible with a diagnosis of TM with a sensory level at Th 12. Cerebrospinal fluid (CSF) demonstrated 32 cells/mL (predominantly lymphocytes), normal glucose and protein levels and elevated IgG levels. The CSF-to-plasma IgG ratio was elevated suggesting intrathecal production. Electromyography (EMG) demonstrated evidence of severe damage to the proximal part of the lower motor neuron. Virus cultures obtained from CSF, stool and throat were negative. Complement fixation tests to tick-borne encephalitis virus, mumps and polio viruses were negative, and there was no change in anti-herpes simplex virus titers (1:16). On follow-up after 5 years, the patient had bladder instability and spasticity of lower extremities. The second child was a previously well 14-year-old girl who developed back pains and frequency of micturition on 23 December 1994, 8 days after being revaccinated with DT, OPV and rubella vaccines. Transverse myelitis with a sensory level at Th 2–3 bilaterally was diagnosed. Magnetic resonance imaging of the spine showed expansion of the cord from C3 to C7. Cerebrospinal fluid demonstrated 21 cells (predominantly lymphocytes), normal glucose and elevated protein (1.69 g/L) levels. Basal myelin protein levels in CSF were elevated, indicating demyelinization. Virus cultures obtained from CSF and stool were negative. Throat culture for Mycoplasma pneumoniae was negative. Acute infection with respiratory viruses, M. pneumoniae, Chlamydia spp. and Borrelia burgdorferi was excluded from negative serology. Serologic evidence of acute Epstein–Barr virus infection was observed (IgM anti-VCA 1:20, IgG anti-VCA 1:320, negative anti-EBNA, converting to negative IgM anti-VCA, IgG anti-VCA 1:160 and positive anti-EBNA), in absence of compatible clinical picture and typical hematological changes. The patient improved after treatment with immunoglobulin for 5 days (2 g/kg cumulative dose) and high-dose steroids. On follow-up, 5 years after acute disease, the patient had unstable bladder and spasticity of lower extremities. Transverse myelitis is a rare disease. In the last 30 years among approximately 90 000 patients hospitalized at our department, there were only two vaccine-associated cases of TM. Transverse myelitis is thought to be an autoimmune-mediated disease following natural infection or immunization with various vaccines: MMR, influenza, hepatitis B, tetanus, DT-pertussis etc.2-6 In patients vaccinated with combined vaccines, it is difficult to determine the component of the vaccine causing TM. The stimulation of T lymphocytes in CSF by vaccine components might help to establish the causative agent. Other causes of TM should also be considered, because TM can be related to an asymptomatic infection, as was probably the case in our second patient. This is not only important from the medical, but also from the vaccine injury compensation perspective." @default.
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• W2415705963 date "2005-08-01" @default.
• W2415705963 modified "2023-10-11" @default.
• W2415705963 title "Letter to the Editor" @default.
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• W2415705963 doi "https://doi.org/10.1111/j.1440-1754.2005.00673.x" @default.
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