Anti-NMDAr Encephalitis and COVID-19 in a Patient With Systemic pANCA-Vasculitis and Recurrent Varicella Zoster Infection

Introduction There is a complex interplay between systemic autoimmunity, immunosuppression, and infections. Any or all of these can result in neurologic manifestations, requiring diligence on the part of neurologists. Case report We herein report a case of a patient on immunosuppressive treatment for a vasculitis that resulted in zoster meningoencephalitis. This was further complicated by the development of anti-NMDAr encephalitis, the etiology of which is undetermined and further discussed in this paper. The patient eventually developed COVID-19 during hospitalization, succumbing to the respiratory infection. Conclusion This case emphasizes that post-infectious autoimmune disorders are becoming increasingly recognized and that they should still be considered in patients who are on immunosuppression. Practitioners should be aware of the complex relationship between autoimmunity and immunosuppression and consider both throughout the disease course.

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The Severe Varicella Zoster Infection with Kidney Transplant Patient Using Immunosuppressant

International Journal of Pharmaceutical Research ◽

10.31838/ijpr/2021.13.01.091 ◽

2020 ◽

Vol 13 (01) ◽

Keyword(s):

Kidney Transplant ◽

Transplant Patient ◽

Kidney Transplant Patient ◽

Varicella Zoster ◽

Varicella Zoster Infection

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Varicella–Zoster Infection in Pregnancy

New England Journal of Medicine ◽

10.1056/nejm198611273152212 ◽

1986 ◽

Vol 315 (22) ◽

pp. 1415-1417 ◽

Cited By ~ 2

Keyword(s):

Varicella Zoster ◽

Varicella Zoster Infection ◽

In Pregnancy

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Reactivation of varicella zoster infection presenting as acute retinal necrosis post COVID 19 vaccination in an Asian Indian male

European Journal of Ophthalmology ◽

10.1177/11206721211046485 ◽

2021 ◽

pp. 112067212110464

Author(s):

Sai Bhakti Mishra ◽

Padmamalini Mahendradas ◽

Ankush Kawali ◽

Srinivasan Sanjay ◽

Rohit Shetty

Keyword(s):

Polymerase Chain Reaction ◽

Asian Indian ◽

Acute Retinal Necrosis ◽

Viral Reactivation ◽

Aqueous Sample ◽

Chain Reaction ◽

Varicella Zoster ◽

Polymerase Chain ◽

Indian Male ◽

Varicella Zoster Infection

Purpose: To present the clinical features of a rare case of varicella zoster infection following one dose of Coronavirus Disease 2019 (COVID-19) vaccination in an elderly Asian Indian male. Methods: Retrospective observational case report. Results: A 71-year-old gentleman presented to us with complaints of reduced vision associated with redness and pain in his right eye for 1 week. On examination he revealed a right eye pan uveitis picture with circumcorneal congestion, multiple fine keratic precipitates, anterior chamber cells and flare, vitritis and widespread areas of acute retinal necrosis. His left eye was within normal limits. Ten days prior to the presentation he had received the first dose of COVID-19 vaccine following which he had developed fever for 2 days that preceded the red eye. The patient’s aqueous sample tested positive for varicella zoster virus (VZV) by nested polymerase chain reaction (PCR) method. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reverse transcriptase polymerase chain reaction (RT-PCR) assay from the aqueous and also from the nasopharyngeal swab was negative. Conclusion and significance: To the best of our knowledge this is the earliest description of a case that has a viral reactivation following COVID-19 vaccination. Elderly people with pre-existing comorbidities, may be at a risk of both primary coronavirus infection and unconceivable risk of aberrant immune reactions leading to a different virus infection or reactivation need to be kept in mind. We present a possible link between SARS-CoV-2 virus vaccination and varicella zoster reactivation in this patient.

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