The first presentation of COVID-19 two hours after vaccination in a patient with multiple sclerosis: Can COVID vaccine provoke cytokine storm in a patient with asymptomatic COVID-19?

Our review aims to highlight the neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the available treatments according to the existing literature, discussing the underlying mechanisms. Since the end of 2019, SARS-CoV-2 has induced a worldwide pandemic that has threatened numerous lives. Fever, dry cough, and respiratory symptoms are typical manifestations of COVID-19. Recently, several neurological complications of the central and peripheral nervous systems following SARS-CoV-2 infection have gained clinicians' attention. Encephalopathy, stroke, encephalitis/meningitis, Guillain–Barré syndrome, and multiple sclerosis are considered probable neurological signs of COVID-19. The virus may invade the nervous system directly or induce a massive immune inflammatory response via a “cytokine storm.” Specific antiviral drugs are still under study. To date, immunomodulatory therapies and supportive treatment are the predominant strategies. In order to improve the management of COVID-19 patients, it is crucial to monitor the onset of new neurological complications and to explore drugs/vaccines targeted against SARS-CoV-2 infection.

Download Full-text

Clinical observation of the course of COVID-19 in patients with multiple sclerosis during ocrelizumab therapy: two clinical cases

Medical Council ◽

10.21518/2079-701x-2021-10-108-111 ◽

2021 ◽

pp. 108-111

Author(s):

E. V. Popova ◽

M. I. Alexandrov ◽

I. A. Trubnikova ◽

S. R. Zeynalova

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Multiple Sclerosis ◽

Clinical Observation ◽

Infectious Complications ◽

Cytokine Storm ◽

Population Average ◽

Risk Patients ◽

Dosing Intervals ◽

Clinical Cases

The COVID-19 pandemic was announced in 2020, and many professional medical societies had to review their algorithms for the management of high-risk patients. In addition to risk factors such as overweight, age over 65 years, cardiovascular disease, diabetes mellitus, and bronchial asthma, other chronic diseases should also be emphasized, taking into account possible immunosuppressive therapy. This publication presents two clinical cases of COVID-19 infection in patients with multiple sclerosis treated with ocrelizumab. During the course of the disease, both patients developed a cytokine storm and were treated with IL-6 blockers. Both cases ended with recovery and a subsequent return to anti-B-cell therapy. Given the mechanism of action of ocrelizumab, there are higher risks of infectious complications, including with COVID-19, but mortality is not higher than the population average. The information published to date may serve as a reason to consider the use of extended dosing intervals to minimize the possible risks of COVID-19 infection, which are probably highest in the first months after infusion.

Download Full-text

Calming the (Cytokine) Storm: Dimethyl Fumarate as a Therapeutic Candidate for COVID-19

Pharmaceuticals ◽

10.3390/ph14010015 ◽

2020 ◽

Vol 14 (1) ◽

pp. 15

Author(s):

Cara A. Timpani ◽

Emma Rybalka

Keyword(s):

Oxidative Stress ◽

Multiple Sclerosis ◽

Respiratory Distress ◽

Treatment Option ◽

Dimethyl Fumarate ◽

Immune Dysregulation ◽

Therapeutic Options ◽

Cytokine Storm ◽

And Oxidative Stress ◽

Viable Treatment

COVID-19 has rapidly spread worldwide and incidences of hospitalisation from respiratory distress are significant. While a vaccine is in the pipeline, there is urgency for therapeutic options to address the immune dysregulation, hyperinflammation and oxidative stress that can lead to death. Given the shared pathogenesis of severe cases of COVID-19 with aspects of multiple sclerosis and psoriasis, we propose dimethyl fumarate as a viable treatment option. Currently approved for multiple sclerosis and psoriasis, dimethyl fumarate is an immunomodulatory, anti-inflammatory and anti-oxidative drug that could be rapidly implemented into the clinic to calm the cytokine storm which drives severe COVID-19.

Download Full-text

The cytokine storm in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/135245859800400104 ◽

1998 ◽

Vol 4 (1) ◽

pp. 12-15 ◽

Cited By ~ 45

Author(s):

Hans Link

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Immune System ◽

Lesion Size ◽

Disease Course ◽

Cytokine Storm ◽

Cytokine Network ◽

Benign Course

MS is associated with a cytokine storm characterized by the parallel upregulation of proinflammatory (IFN-g, TNF-a, and b, and IL-12) and immune response-down-regulating (TGF-b, IL-10) cytokines. Also IL-6 and the cytolytic molecule perforin are upregulated. Even when evaluated in individual MS patients over the disease course, no Th1/Th2 dichotomy is obvious but, instead, upregulation of Th1+Th2+Th3 cytokines simultaneously, probably reflecting the complex pathology of MS in lesion size, time and distribution in the indiviual patient. Few correlations have been observed between cytokines and clinical MS variables, though upregulation of TGF-b seems to correlate with benign course and minor disability. Both pro- and antiinflammatory cytokines are also produced by microglia and astrocytes, constituting a CNS-cytokine network that interacts with the cytokine network of the immune system. This complexity is to be kept in mind when searching for cytokine abnormalities in MS.

Download Full-text