Suspicion of autoimmune limbic encephalitis in post COVID-19 vaccine

Abstract

Background: Empirical studies have so far demonstrated associations between COVID-19 and psychiatric manifestations. Research is still ongoing to know more about this novel virus responsible for the COVID-19 Infection. Several strains of the COVID-19 Vaccines were developed at the peak of the pandemic to combat this great challenge to human health and life with each vaccine having its own unique characteristics. It is established that autoimmune reactions could occur following vaccinations or viral infections. This case is presented to point attention toward the possibility of psychiatric symptoms arising as post-COVID-19 Vaccine autoimmune-related reactions. Case presentation: A Nigerian woman in her 50s with 1st episode of psychiatric disorder is reported here. She was mentally stable until day 2 of receiving the 2nd dose of the Astra Zeneca COVID-19 vaccine. She developed symptoms with a similar profile with a diagnosis of mania with psychotic symptoms, with a differential diagnosis of an organic psychotic disorder. All symptoms resolved within 2 weeks of commencement of treatment. In addition, there was a preceding history of a mild fever and cough following the second dose of the COVID-19 vaccine which spontaneously resolved giving way to the psychiatric symptoms manifestations. All these raise the index of suspicion that there could have been an autoimmune limbic encephalitis precipitated by the COVID-19 Vaccine administration. Important discussion points: The coincidence of 1st episode of Bipolar affective symptoms at the mid-life stage, preceded by 2 days of COVID-19 vaccine and genetic predisposition in the reported case calls for attention. Studies have shown that the COVID-19 vaccine may induce autoimmune conditions such as myocarditis, thrombotic thrombocytopenia, and IgA vasculitis. These reactions are commoner in middle-aged Females. Susceptibility to these reactions has a strong association with genetic predisposition and the limbic region of the brain that controls human emotions is a highly susceptible area. Thus, the COVID-19 vaccine autoimmune response may be an epiphenomenon in an individual with a likely risk of mental illness. Conclusion: This report could represent a rare occurrence. Also, the absence of needed investigative results caused by financial and logistic constraints could hamper making the obvious conclusions of a temporal relationship between the COVID-19 vaccine and post-vaccination affective disturbance. It is however worthy of note that this is an important study area to look into for future research work.