PMC10036343_01
Brain and spinal MRI during post-SARS-CoV-2 infection-induced ADEM. Acute inflammatory contrast-enhancing T1 MRI lesions on the left middle cerebellar peduncle (A), longitudinal extensive transverse myelitis from the lower part of the medulla oblongata to C3 (C); [panel (B) shows axial plane, i.e., yellow line on panel (C)] with edema lesion on T2 (F) reaching C4, on level C5/C6 (C, F), and on the ventral conus (E); [panel (D) shows axial plane, i.e., yellow line on panel (E)].
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F1
T2 lesion reaching C4), on level C5/C6, and on the ventral conus (Figure 1). Cerebrospinal fluid (CSF) analysis showed mild lymphocytic pleocytosis (13 cells/mul), and a slightly increased protein level (64 mg/dl), while glucose and lactate levels were normal. The albumin ratio was elevated (10.7 x 10-3) and the immunoglobulin G (IgG) index was normal.
Timeline of clinical events and treatments.
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F2
See Figure 2 for timeline of the case.
Measurement of antibodies against SARS-CoV-2 variants. Serum (A, C) and cerebrospinal fluid [CSF, (B, D)] collected during first vaccine-induced ADEM episode (T1, upper row) and during infection-induced ADEM episode (T2, lower row) analyzed using the SARS-CoV-2 variants of concern ViraChip  immunoglobin G (IgG) test. This protein microarray detects IgG specific to SARS-CoV-2 surface [spike protein 1 (S1), receptor binding domains of the Wuhan (RBD), delta (RBDd), and omicron (RBDo) variants of concern, and spike protein 2 (S2)] as well as to the nucleocapsid antigen (N). RBDs are provided with high (RBD-1/RBDd-1/RBDo-1) and low (RBD-2/RBDd-2/RBDo-2) antigen concentrations. (A) Serum at T1 shows typical post-vaccine serum pattern with significant S1/RBD/RBDd/S2 but no N reactivity. (C) At T2, massive increase in serum reactivity including to RBDo and N confirms recent omicron variant infection. The synchronous mild increase in CSF reactivity from T1 (B) to T2 (D) proves blood-brain barrier patency of all surface and nucleocapsid IgG. BAU/ml, binding antibody units per milliliter; red/blue/green marking indicates high/moderate/low antigen-IgG reactivity.
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F3
SARS-CoV-2 infection) were analyzed (Figure 3). Serum reactivity constellation at T1 was well compatible with post-vaccination status (i.e., S1/RBD/RBDd/S2-IgG positive with no N-IgG).