[A severe episode in a patient with recurrent disseminated
acute encephalitis due to vaccination against hepatitis b. For or against
vaccination?]
[Article in Spanish]
Cabrera G mez JA, Echaz bal Santana N, Garc a Gonz lez L, Ramos Cede o AM,
Rodr guez Roque MO, L pez Hern ndez O, Cabrera N ez JA, Gonz lez De La Nuez J,
T llez L.
Centro de Esclerosis M ltiple. Servicio de Neurolog a; Hospital Universitario
Cl nico Quir rgico Dr. Gustavo Alderegu a Lima, Cienfuegos, 55 100, Cuba.
cabrera@jagua.cfg.sld.cu
INTRODUCTION. Several reports of new cases of CNS demyelination or
reactivation of MS after hepatitis B vaccination have raised the possibility
of a causal relationship. Conversely, some authors have concluded that the
risk of developing a demyelinating CNS event after a hepatitis B vaccination
is unknown. PATIENTS AND METHODS. We have observed a 40 year old man, with
diabetes mellitus (DM) type 1 and a previous history of recurrent acute
demyelinating encephalomyelitis (rADEM). The patient had experienced three
episodes of neurological dysfunction and he fulfilled the criteria for
definite clinical MS but MRI showed demyelinating lesions in the pons and
cerebellum without MRI criteria of MS. CSF analysis showed oligoclonal
banding. The patient had been clinically stable during the last 6 years.
Yearly MRI during this period had not shown any new disease activity. He was
admitted in our MS Clinic due to dizziness, nausea, vomiting and diplopia, 6
weeks after the first of the two injections for hepatitis B vaccine after
participating in the national programme of vaccination in DM type 1 patients.
Clinical examination showed intranuclear ophtalmoplegia, visual loss in the
left eye and worsening of the previous cerebellar and pyramidal signs. MRI
showed an increase in the old lesions with high intensity signals on T2
weighted sequences with post gadolinium enhancement on T1 weighted sequences
located in the brainstem and mesencephalon. The patient s diabetes mellitus
deteriorated with ketoacidosis that needed increased doses of insulin. His
condition worsened and he developed partial motor seizures. He improved 15
days later but he still had involvement of the cerebellar and pyramidal
systems and occasional dizziness. CONCLUSIONS. As pointed out by some authors
and in view of this observation, it would seem reasonable, as a precautionary
measure, to avoid hepatitis B vaccination in patients with a personal or
family history of symptoms suggestive of a demyelinating disease of the CNS.
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MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.