Case Report: New-onset relapsing-remitting multiple sclerosis with positive Uhthoff phenomenon after second BNT162b2 dose

Abstract

Objectives new-onset relapsing-remitting multiple sclerosis (RRMS) has rarely been communicated as a side effect of SARS-CoV-2 vaccination (SC2V). Here we report a patient with new-onset RRMS shortly after the second BNT162b2 vaccine dose, which was diagnosed only after a relapse after the third vaccine dose. Case report the patient is a 31 year-old male who developed eye problems 48 days after the second dose of BNT162b2. The symptoms were attributed to eye strain and gradually disappeared without treatment. Further workup was negative. Three months after the third BNT162b2 dose, urinary urgency developed. Eleven months after the third BNT162b2 dose, he developed sensory and visual disturbances that were noticeable post-exercise and progressed and worsened with alcohol and heat. MRI showed typical lesions that met the Barkhof/Tintore criteria for RRMS. Cerebrospinal fluid (CSF) studies revealed elevated kappa free light chains and positive oligoclonal bands. Because the revised McDonalds criteria were met, RRMS was diagnosed and ocrelizumab was started. Conclusions this case shows that SARS-CoV-2 vaccination can trigger new-onset RRMS, the clinical presentation of SC2V-induced multiple sclerosis is similar to multiple sclerosis due to other triggers, and the severity of the relapses may increase with the number of boosters given. Although, rare, a neurologist should be aware of the presumably rare event in which SC2V triggers new-onset multiple sclerosis.