2279 Severe refractory antibody-positive autoimmune pandysautonomia post-COVID19 vaccinaton: a case report

• Published in: BMJ neurology open 2022-08, Vol.4 (Suppl 1), p.A29-A29
• Main Authors: Rowe, Simon P, Calic, Zeljka, Spies, Judith, Urriola, Nicolás
• Format: Article
• Language: English
• Subjects: Abstracts; Antibodies; Vaccines
• ISSN: 2632-6140
• DOI: 10.1136/bmjno-2022-ANZAN.76

BackgroundCOVID-19 vaccine-associated peripheral and central neuroimmunological disorders have been well described. We present the case of a 57 year old male who developed α3-ganglionic AChR antibody positive Autoimmune Autonomic Ganglionopathy (AAG) after completion of a two-dose course of mRNA (Cominarty) vaccination for COVID19.ResultsA previously hypertensive 57 year old Vietnamese male presented with the subacute sequential onset of severe constipation, urinary retention, erectile dysfunction, sudomotor failure, sicca symptoms, non-reactive pupils and severe orthostatic hypotension shortly after receiving the second dose of an mRNA vaccine against COVID19. Autonomic testing revealed severe cardiovagal, adrenergic and sudomotor impairment, and tonic ‘half-mast’ pupils with evidence of sympathetic and parasympathetic denervation. Nerve conduction studies were normal. Investigations for common causes of autonomic failure were non-contributory to a diagnosis. Pathological α3-ganglionic ACHR antibodies were positive in serumas detected by a new flow cytometric immunomodulation assay. Malignancy was excluded. The patient was diagnosed with severe, treatment resistant acute pandysautonomia (AAG).ConclusionsWhile autonomic dysfunction has been previously reported post-COVID19 vaccination, to our knowledge this is the first reported case of antibody-positive AAG in this setting. The severity of this case is in marked contrast to the existing literature on idiopathic antibody-positive autoimmune pandysautonomia.