Small fiber neuropathy with normal intra-epidermal nerve fiber density but reduced sweat gland density after third BNT162b2 shot

Josef Finsterer

Abstract


Small fiber neuropathy (SFN) has not been reported after the third dose of BNT162b2 in a previously healthy vaccinee. A 44-year-old previously healthy female developed pain and sensory disturbances in varying locations after the third BNT162b2 dose. Additionally, she developed recurrent tinnitus, headaches, arthralgia, neck stiffness, and motor dysfunction. A skin biopsy five months after symptom onset revealed normal intra-epidermal nerve fiber density (IENFD) but reduced sweat gland nerve fiber density. She is intended for a first series of intravenous immunoglobulins. SARS-CoV-2 vaccinations may be complicated by SFN; the diagnosis SARS-CoV-2 vaccination SFN may be delayed; IENFD may be normal, but sweat gland nerve fiber density may document SFN; and full recovery after SFN cannot always be achieved quickly.

Keywords


small fiber neuropathy; skin biopsy; sweat gland nerve fiber density; SARS-CoV-2 vaccination; side effect

Full Text:

PDF

References


Finsterer J, Scorza FA. Small fiber neuropathy. Acta Neurol Scand. 2022;145(5):493-503. doi: 10.1111/ane.13591. PMID: 35130356.

Egenolf N, Zu Altenschildesche CM, Kreß L, et al. Diagnosing small fiber neuropathy in clinical practice: a deep phenotyping study. Ther Adv Neurol Disord. 2021;14:17562864211004318. doi: 10.1177/17562864211004318. Erratum in: Ther Adv Neurol Disord. 2021;14:17562864211036650. PMID: 34335876; PMCID: PMC8283814.

Khokhar F, Khan A, Hussain Z, Yu J. Small Fiber Neuropathy Associated With the Moderna SARS-CoV-2 Vaccine. Cureus. 2022;14(6):e25969. doi: 10.7759/cureus.25969. PMID: 35812635; PMCID: PMC9259076.

Safavi F, Gustafson L, Walitt B, et al. Neuropathic symptoms with SARS-CoV-2 vaccination. medRxiv [Preprint]. 2022:2022.05.16.22274439. doi: 10.1101/2022.05.16.22274439. PMID: 35611338; PMCID: PMC9128783.

Watad A, De Marco G, Mahajna H, et al. Immune-Mediated Disease Flares or New-Onset Disease in 27 Subjects Following mRNA/DNA SARS-CoV-2 Vaccination. Vaccines (Basel). 2021;9(5):435. doi: 10.3390/vaccines9050435. PMID: 33946748; PMCID: PMC8146571.

Abbott MG, Allawi Z, Hofer M, et al. Acute small fiber neuropathy after Oxford-AstraZeneca ChAdOx1-S vaccination: A report of three cases and review of the literature. J Peripher Nerv Syst. 2022;27(4):325-329. doi: 10.1111/jns.12509. PMID: 35962630; PMCID: PMC9538519.

Schelke MW, Barcavage S, Lampshire E, Brannagan TH 3rd. Post-COVID-19 vaccine small-fiber neuropathy and tinnitus treated with plasma exchange. Muscle Nerve. 2022;66(4):E21-E23. doi: 10.1002/mus.27696. PMID: 35934893; PMCID: PMC9537871.

Waheed W, Carey ME, Tandan SR, Tandan R. Post COVID-19 vaccine small fiber neuropathy. Muscle Nerve. 2021;64(1):E1-E2. doi: 10.1002/mus.27251. PMID: 33851437; PMCID: PMC8250971.




Copyright (c) 2023 Josef Finsterer

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

ISSN: 2360-6975