68.: Acute meningomyelitis following diphtheria, tetanus, pertussis booster vaccination in a young adult

We report a case of severe post-vaccinal menigomyelitis in a 30-year-old man with symptom onset a week after of administration diphtheria, tetanus, pertussis booster vaccination (Boostrix; GlaxoSmithKline, Brentford, Middlesex, UK). The case highlights the characteristic features of post-vaccinal myelitis and raises some interesting issues. There were no other precipitating factors and extensive infection and other etiological screening was unremarkable. The patient responded well to corticosteroids and rehabilitation. There was a lymphocytic pleocytosis on cerebrospinal fluid analysis and a raised opening pressure along with increased body temperature and normal initial MRI of the spine, despite having signs suggestive of a upper thoracic myelopathy for 1 week. This led to extensive investigations for an infective cause. Spinal MRI changes can lag behind clinical signs and symptoms of myelopathy and a repeat scan a week later showed three distinct areas of cord signal abnormalities involving the cervical and thoracic cord. Fever can be a part of an inflammatory response but does not necessarily reflect an infective etiology. Vaccinations are important but in rare cases serious neurological sequelae can occur.