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Case Reports
. 2015 Apr 11;7(1):78-83.
doi: 10.1159/000381826. eCollection Jan-Apr 2015.

Seronegative Neuromyelitis Optica Spectrum Disorder Following Exposure to Hepatitis B Vaccination

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Free PMC article
Case Reports

Seronegative Neuromyelitis Optica Spectrum Disorder Following Exposure to Hepatitis B Vaccination

Richard Heekin et al. Case Rep Neurol. .
Free PMC article

Abstract

Controversy exists regarding a potential link between exposure to recombinant hepatitis B vaccine (HBV) and central nervous system demyelinating diseases. Here, we present a case of seronegative neuromyelitis optica spectrum disorder (NMOSD) following exposure to HBV. A 28-year-old man developed painful eye movements 11 days after exposure to HBV. Within 24 h, he experienced vision loss, ascending numbness, and ataxia. T-spine MRI showed a cord lesion spanning T6-T9. Brain MRI showed bilateral optic nerve contrast enhancement and a right-sided internal capsule lesion. Cerebrospinal fluid analysis was normal, including negative oligoclonal bands and normal IgG index. AQP4-IgG serology was negative. The patient's visual symptoms improved after treatment with steroids and plasma exchange. He received plasma exchange weekly for 4 weeks with decreased numbness and tingling as well as improved coordination. Treatment with mycophenolate mofetil was started, and the patient remains clinically stable with near resolution of his prior symptoms. Neuromyelitis optica is characterized by optic neuritis and/or longitudinally extensive transverse myelitis. While our patient tested seronegative for AQP4-IgG (which remains negative in 10-50% of NMOSD cases, despite testing with the most sensitive assays available), he did meet NMOSD diagnostic criteria. In a literature review, we found 7 cases of NMOSD onset or relapse associated with exposure to various vaccines, but to our knowledge this represents the first published report of NMOSD onset following exposure to HBV. While causality between vaccination and CNS demyelinating disease remains elusive, it is important to report these cases to help develop safer vaccinations and provoke further inquiry into the pathogenesis of NMOSD.

Keywords: Demyelination; Hepatitis B vaccine; Neuromyelitis optica; Optic neuritis; Transverse myelitis.

Figures

Fig. 1
Fig. 1
MRI of the thoracic spine: sagittal T2 sequence partially demonstrating a hyperintenseT6–T9 intramedullary lesion along with an isolated hyperintense T5 lesion.
Fig. 2
Fig. 2
MRI of the brain: T1 coronal post-contrast sequence demonstrating faint bilateral optic nerve enhancement.
Fig. 3
Fig. 3
MRI of the brain: T2 FLAIR axial sequence demonstrating a solitary hyperintense lesion at the junction of the right thalamus and the posterior limb of the internal capsule.

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