[Acute transverse myelitis secondary to hepatitis B
vaccination]
[Article in Spanish]
Iniguez C, Mauri JA, Larrode P, Lopez del Val J, Jerico I, Morales F.
Servicio de Neurologia, Hospital Clinico Universitario de Zaragoza, Espana.
ciniguezm@nacom.es
INTRODUCTION: Acute transverse myelitis is an inflammatory disorder. The
pathogenesis is unclear, but the probable mechanism involves an autoimmune
phenomenon. Possible causes included multiple sclerosis and parainfectious and
postvaccinal events. Myelitis has rarely been reported secondary to vaccinations
including hepatitis B. We present a case of acute myelitis, which seems
secondary to the administration of the hepatitis B vaccine. CLINICAL CASE: A
15-years-old female presented with progressive numbness of the right arm and
leg, with right leg weakness. Symptom began one week after receiving the first
dose of the hepatitis B vaccine. Spinal cord magnetic resonance (MR) revealed a
diffuse increased signal extending from C6 to D2. Cerebral MR and cerebrospinal
fluid were normal. She was treated with high doses of methylprednisolone with a
complete recovery of neurological functional. Repeat medullar cord MR was
normal. There was no relapse during a four years follow up. CONCLUSIONS:
Potential causal relationship between vaccination against hepatitis B and
multiple sclerosis was brought to the attention and to public debate. However,
no conclusive association could be made between vaccination and demyelination.
In the clinical setting, the distinction between a first episode of multiple
sclerosis or postvaccinal myelitis depends upon subsequent course.
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