Two Pediatric Cases of Initial Manifestation of Multiple Sclerosis After Immunization with the Pfizer-BioNTech COVID 19 Vaccine

Objectives: Vaccination against SARS-CoV-2 is crucial to control the pandemic. Similar to other cronic diseases, vaccination against the SARS-CoV-2 virus is generally recommended in Multiple sclerosis (MS). On the other hand, reactivation or new-onset demyelinating disease after vaccination against SARS-CoV-2 was published in the literature in old patients. We presented two pediatric cases newly diagnosed with MS after Pfizer-BioNTech COVID-19 vaccine. Case presentations: In the first case, a 17 year-old girl was admitted to emergency department with headache, diplopia and ataxia. On brain MRI there were demyelinating plauqes on jusctacortical, periventricular and infratentorial areas and 2 of them were Gadolinium enhanced plaques. Then, she was diagnosed with MS and administered pulse steroid for 5 days. After only one week interval, the second case, a 15 year-old boy referred to outpatient clinic with right sided hemi-hypoesthesia. A brain MRI showed several subcortical-cortical T2 hyperintense white matter lesions with brainstem and pericallosal lesions. Moreover, one of them showed abnormal gadolinium enhancement. After relevant diferential diagnoses were excluded, he was diagnosed with relapsing MS according to the 2017 McDonald criteria and initiated high-dose glucocorticoid therapy. Both patients were evaluated for differential diagnosis and there was nothing significant. They were vaccinated with Pfizer-BioNTech COVID-19 vaccine and each patient’s symptoms started one month after vaccination. Conclusion: Our cases suggest a possible link between the vaccination and the clinical MS attack. Therefore, the rarity of case reports, such as ours, may support the idea that the benefits of vaccination against SARS-CoV-2 far outweigh the potential risks.
Keywords: Multiple Sclerosis, Pfizer-BioNTech COVID-19 vaccine, Pediatric