Acute fulminant demyelination After the COVID-19 Vaccine: A Case Report and Review of the Literature

Introduction: COVID-19 vaccination campaigns have successfully limited the spread of the disease and reduced its severity. Neurological side effects of COVID-19 vaccines are rare. To the best of our knowledge, only a few case reports have shown an association between the COVID-19 vaccine and the development of acute fulminant demyelination. Case presentation: In this case report, we investigated and documented the association between COVID-19 vaccine and acute fulminant demyelination, supported by a review of the existing literature. We describe the case of a 30-year-old female who experienced severe neurological symptoms, including memory loss, disorientation, paranoia, hallucinations, and urinary incontinence, just three days after receiving the Pfizer-BioNTech COVID-19 vaccine booster. Magnetic resonance imaging MRI revealed multiple T2 lesions with contrast enhancement consistent with demyelination. The condition rapidly progressed to somnolence, disorientation, aphasia, and quadriparesis. Treatment was initiated with pulse intravenous methylprednisolone, plasma exchange, prednisolone, natalizumab, and high-dose cyclophosphamide, resulting in disease stabilization, which was complicated by febrile neutropenia and meningitis. Fortunately, gradual improvement was observed, with MRI showing no new lesions on the follow-up imaging. Conclusion: The literature review revealed limited case reports on COVID-19 vaccine-induced central nervous system demyelination, with no consensus on its link to the Marburg variant of multiple sclerosis. This case highlights the heterogeneity of MS pathogenesis, risk factors, and challenges in managing severe clinical deterioration. Given the rare nature of Marburg MS, early detection and management of the disease lead to a better outcome and prognosis. Word count: 2,089 words, excluding references.