Mattia Iacobaeus
Acute hemorrhagic encephalomyelitis (AHEM) is a relatively uncommon hyperacute form of acute disseminated encephalomyelitis (ADEM). The disease is distinguished by fulminant inflammation and demyelination of the brain and spinal cord, and it is frequently preceded by an infection or vaccination. A 53-year-old man with rheumatoid arthritis and ongoing methotrexate and etanercept treatment developed fatal AHEM after receiving the second dose of the COVID-19 vaccine. Multiorgan thromboembolic disease complicated the disease course, as did the presence of high/moderate levels of cardiolipin IgG antibodies and anti-beta-2 glycoprotein 1 IgG antibodies, indicating a possible antiphospholipid syndrome. Immunosuppressive therapy failed to improve the situation. Comprehensive clinical, neuroimaging, and neuropathological findings are included in the report. The case focuses on diagnostic challenges in a patient who has multiple diagnoses. preceding risk factors, such as autoimmune disease, immunotherapy, and vaccination, may have pathophysiological implications. Although evidence cannot be established, the temporal association with the COVID-19 vaccination may suggest possible causality. Reporting potential adverse events following COVID-19 vaccination is critical for identifying at-risk populations and achieving pandemic control.
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