Recurrent demyelination attacks after BNT162b2 vaccination: Two case reports and literature review

Abstract

We describe two cases with recurrent demyelinating attacks following BioNTech BNT162b2 immunization. No reports of any recurring demyelinating attack cases connected to COVID-19 immunization. Case-1: A 37-year-old male patient was admitted due to diplopia and ptosis. Neurological examination showed isolated oculomotor cranial paralysis on the right side. The second dose of BNT162b2 was given 10 days ago. On T2- and fluidattenuated inversion recovery (FLAIR)-weighted magnetic resonance imaging (MRI), hyperintense lesions were seen in the pons on T1, with no evidence of contrast enhancement. We diagnosed the patient with central pontine myelinolysis associated with BNT162b2. Six months later after the first attack, a new lesion appeared in the same region. Case-2: He applied to the hospital at the age of 57 years, complaining of numbness in his hands and feet, confusion, and cooperation disorder. During the neurological assessment, apathy, cooperation, and orienting disorders were found. Hyperintense lesions were seen in both hemispheres, with cortico-subcortical localization on MRI. The patient received the BNT162b2 two weeks ago. After the initial attack six months ago, new clinical signs and an increase in demyelinating lesions were found. Despite early corticosteroid treatment, BNT162b2 immunization may be associated with repeated demyelination attacks. In patients with diffusion restriction on MRI, we might suggest using corticosteroid therapy for approximately one year, a lot longer than the literatures suggested.