Demyelinating disease and polyvalent human papilloma virus vaccination.

Since its inception, the polyvalent vaccine against the human papilloma virus (HPV), Gardasil, has generated some controversies as a temporal relationship between the administrations of the vaccine and the development of a few autoimmune diseases, such as acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS) and Guillain–Barre syndrome have been reported.1–3 We encountered two cases whose initial presentation of CNS demyelination followed in close time relationship the administration of Gardasil vaccine and we discuss their possible association. A 19-year-old woman received two doses of Gardasil, 3 months apart, and approximately 1 month after the second dose, she developed numbness to the right foot that within 1 day extended to the contralateral foot and was associated with mid-thoracic back pain. Her neurological examination was only significant for the altered perception to touch to the feet. Deep tendon reflexes were normal and plantar reflexes in flexion. MRI of cervical and thoracic spine revealed a total of three lesions with characteristic demyelinating appearance, one of those in the thoracic spine was contrast-enhancing (figure 1A–C). MRI brain demonstrated one additional white matter lesion also consistent with a demyelinating process. Figure 1 MRI scans for case No 1 (A–I) and case No 2 (J–P). MRI of the spine in case No 1 obtained at the onset of symptoms. Two areas of signal abnormalities are shown in the thoracic cord (A, B), one of which is contrast enhancing (C). MRI of the brain of case No 1 obtained at …