Departmento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Departamento de Epidemiologia, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil; Universidade Nove de Julho.
J Neuroimmunol. 2021 Jun 15;355:577548. doi: 10.1016/j.jneuroim.2021.577548. Epub 2021 Mar 17.
Meningoencephalitis following yellow fever vaccination is considered a viral neuroinvasive disease. We describe three patients with typical autoimmune encephalitis syndromes that developed 1-27 days following yellow fever vaccination. Anti-N-methyl-d-aspartate-r antibodies were identified in the CSF and serum of two patients and the other case was associated with anti-neurexin-3 antibodies. One case was confirmed as vaccine-associated neurotropic disease due to reactive CSF yellow fever IgM, which suggested an infectious-autoimmune overlap mechanism. Two aditional cases of Anti-N-methyl-d-aspartate-r encephalitis were identified in the literature review. Antibody-positive autoimmune encephalitis should be included in the differential diagnosis of neurologic adverse events following yellow fever vaccination.
黄热病疫苗接种后发生脑膜脑炎被认为是一种病毒性神经侵袭性疾病。我们描述了三例患者,他们在黄热病疫苗接种后 1-27 天出现典型的自身免疫性脑炎综合征。两例患者的 CSF 和血清中检测到抗 N-甲基-D-天冬氨酸受体抗体,另一个病例与抗神经连接蛋白-3 抗体有关。由于反应性 CSF 黄热病 IgM,一例病例被确认为疫苗相关性神经毒性疾病,这表明存在感染性-自身免疫性重叠机制。文献复习中还发现了另外两例抗 N-甲基-D-天冬氨酸受体脑炎病例。抗体阳性的自身免疫性脑炎应纳入黄热病疫苗接种后神经不良反应的鉴别诊断。