He continued to spike a fever in the range of 102–103 ☏, with no specific pattern noted, he had intermittent staring spells, and increased somnolence. On hospital days 2–3, the patient had not improved. Other miscellaneous results, including results for urinalysis, parvovirus, and SARS-CoV-2, were all unremarkable. CSF culture for fungi, bacteria, and viral panel were all negative. Gram stain and fungal culture of the CSF were negative. The possibility of viral encephalitis was a principal concern. Magnetic resonance imaging (MRI) demonstrated increased abnormal fluid-attenuated inversion recovery (FLAIR) signals in the bilateral mesial temporal and anterior inferior frontal lobes, with small, scattered, ill-defined faint foci of enhancement (Fig. Serum protein electrophoresis was unremarkable. Other tests on the CSF included a nonreactive venereal disease research laboratory (VDRL) screen, negative oligoclonal bands, and negative JC virus Deoxyribonucleic acid (DNA) polymerase chain reaction (PCR). Analysis of the CSF revealed an elevated protein level of 119 mg per deciliter (reference range of 25–55 mg per deciliter), normal glucose concentration 52 mg per deciliter (reference range of 45–75 mg per deciliter), high leukocyte count of 300 per millimeter cube (reference range of 0–8 per millimeter cube), and neutrophilic pleocytosis with 72% polymorphonuclear cells. The cerebrospinal fluid (CSF) was colorless with normal opening pressure. The remainder of the complete blood count, liver function test, and complete metabolic profile were unremarkable. Antinuclear antibodies, myeloperoxidase and proteinase-3, antineutrophil cytoplasmic antibody (ANCA), and complement proteins were normal. C reactive protein was normal at 0.5 mg per liter (reference range of < 3 mg per liter). Laboratory work-up showed an elevated erythrocyte sedimentation rate (ESR) of 44 mm per hour (reference range of 0–20 mm per hour). The rest of the motor and sensory examination was unremarkable. There was no neck stiffness or focal neurological signs. He was responding to all questions appropriately. He had a fever of 102.6 ☏, tachycardia of 115 beats per minute, and elevated blood pressure of 157/67 mmHg. On physical examination at the time of presentation, he was alert and oriented to time, place, and person. He had no personal or family history of autoimmune disease. His family reported that his episodes of fever were associated with confusion, which would resolve after taking acetaminophen. On the day of presentation, the patient woke up with a fever, excessive sweating, and an inability to answer questions appropriately. He was treated symptomatically with acetaminophen and nonsteroidal antiinflammatory drugs. Initial work-up by his PMD revealed no abnormalities. He had visited his primary medical doctor (PMD) a week prior to presentation. His symptoms started 4 days after he received his first dose of the mRNA-1273 (Moderna) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. We present a case of a 69-year-old Hispanic male with no significant past medical history, who presented to the emergency department (ED) with complaints of fever and confusion for 3 weeks. In this report, we describe a case of a 69-year-old otherwise healthy male who presented with acute fever and confusion 4 days after receiving the first dose of the messenger RNA (mRNA)-1273 (Moderna) vaccine. Treatment includes steroids and immunosuppressive agents. With no specific defining test, the diagnosis is usually made on the basis of medical history and exclusion of other plausible causes, such as Central Nervous System (CNS) infections, cerebrovascular accidents, malignancy, and autoimmune conditions. Īcute disseminated encephalomyelitis (ADEM) is a well-known, but rare, side effect of some vaccines or symptom following a febrile illness, especially in children. Reported adverse effects of vaccines have ranged from mild symptoms, such as fever, injection site reactions, and headaches, to more severe reactions such as thromboembolic phenomenon and functional neurological disorders. With over 4.5 million lives lost to the coronavirus disease 2019 (COVID-19) pandemic globally, the development of COVID-19 vaccines, which have come to save millions of lives, has been timely indeed.
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