J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Case Report

Volume 15, Number 1, January 2025, pages 56-61

Possible Autoantibody-Negative Autoimmune Encephalitis in a Sixty-Four-Year-Old Man Post-Varicella-Zoster Virus Vaccination

↓ **Table 1.** Lumbar Puncture Findings of Patient During Hospital Stay
Laboratory value	Day 1	Day 4	Day 10	Reference ranges
White blood cell count	1 cell/µL	0 cells/µL	2 cells/µL	0 - 5 cells/µL
Lymphocyte percentage	89%	-	60%	40-80%
Protein	90 mg/dL	42 mg/dL	55 mg/dL	15 - 45 mg/dL
Glucose	72 mg/dL	54 mg/dL	73 mg/dL	50 - 80 mg/dL

↓ Table 1. Lumbar Puncture Findings of Patient During Hospital Stay

Laboratory value

Day 1

Day 4

Day 10

Reference ranges

White blood cell count

1 cell/µL

0 cells/µL

2 cells/µL

0 - 5 cells/µL

Lymphocyte percentage

89%

60%

40-80%

Protein

90 mg/dL

42 mg/dL

55 mg/dL

15 - 45 mg/dL

Glucose

72 mg/dL

54 mg/dL

73 mg/dL

50 - 80 mg/dL

↓ **Table 2.** Clinical Cases of Autoimmune Encephalitis Following Vaccination
Case	Sex	Age	Etiology	Time until onset	Symptoms	Positive lab and imaging findings	Effective treatment and course
All 11 cases of vaccine-associated AIE in the literature and their associated characteristics are reported and described. Of note, other cases have been reported, but not described within the literature [8, 16]. AIE: autoimmune encephalitis; COVID-19: coronavirus disease 2019; CSF: cerebrospinal fluid; EEG: electroencephalogram; IVIG: intravenous immunoglobulin; LP: lumbar puncture; NMDAR: N-methyl-D-aspartate receptor; PLEX: plasmapheresis; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WBC: white blood cell.
Coecklebergh and Reynders, 2021 [7]	M	29	Yellow fever vaccine	2 to 3 days post-vaccination	Systemic, neurological, movement, autonomic	Anti-NMDA antibodies in serum and CSF. LP: WBC 1 cell/µL, protein 54 mg/dL	Spontaneous remission after 3 weeks with no intervention
Hozakova et al, 2018 [8]	F	17	Yellow fever vaccine	27 days post-vaccination	Systemic, neurological, psychiatric	Anti-NMDAR antibodies in serum and CSF. EEG: slow wave delta activity.	-
Hofmann et al, 2011 [9]	F	15	Tetanus diphtheria pertussis and polio vaccine (TdaP-IPV)	1 day post-vaccination	Systemic, psychiatric, movement, neurological, autonomic	Anti-NMDAR antibodies in serum and CSF	-
Wang, 2017 [10]	F	2	Japanese encephalitis vaccine	14 days post-second dose of JE vaccination	Systemic, psychiatric, neurological, movement	Anti-NMDAR antibodies in CSF	IVIG
Abu-Abaa et al, 2022 [11]	M	75	mRNA COVID-19 vaccine	1 day post-vaccination	Neurological, psychiatric	LP: WBC 9 cells/µL, 62% lymphocytes, protein 76 mg/dL, glucose 75 mg/dL. Myelin basic protein 29.6 ng/mL.	Complete resolution over 5-day hospitalization without active intervention.
Sluyts et al, 2022 [12]	M	48	mRNA COVID-19 vaccine	6 days post-vaccination	Psychiatric, neurological	LP: WBC 34 cells/µL, 95% lymphocytes, protein 107 mg/dL.	Complete resolution over 1 week of hospitalization without active intervention.
Peraita-Adrados and Bravo-Quelle, 2024 [13]	M	23	mRNA COVID-19 vaccine	7 weeks post-vaccination	Systemic, neurological, psychiatric, autonomic	Positive SARS-CoV-2 antigen test. LP: highly elevated protein and lymphocytic pleocytosis. Diffusion weighted MRI showed high signal in left hemisphere involving cerebral cortex, temporal, and frontal lobes.	Six cycles of PLEX with daily 1 g corticosteroid, followed by steroid taper.
Takata et al, 2021 [14]	F	22	ChAdOx1 nCoV-19 vaccine	A few days post-vaccination	Systemic, neurological, psychiatric	LP: WBC 18 cells/µL, 100% lymphocytes, IgG oligoclonal bands.	Olanzapine, with continued maintenance dose and follow-up as she has not fully recovered post-discharge.
Zuhorn et al, 2021 [15]	F	21	ChAdOx1 nCoV-19 vaccine	5 days post-vaccination	Neurological	LP: WBC 46 cells/µL. EEG: diffuse abnormally slow theta rhythms.	10 mg dexamethasone with significant improvement.
Zuhorn et al, 2021 [15]	F	63	ChAdOx1 nCoV-19 vaccine	6 days post-vaccination	Neurological, psychiatric, movement	LP: WBC 115 cells/µL. EEG: diffuse abnormally slow theta rhythms.	5 g methylprednisolone over 5 days led to immediate improvement.
Zuhorn et al, 2021 [15]	M	63	ChAdOx1 nCoV-19 vaccine	8 days post-vaccination	Systemic, neurological	LP: WBC 7 cells/µL.	Steroid immunotherapy rejected by patient, complete resolution over several weeks.

↓ Table 2. Clinical Cases of Autoimmune Encephalitis Following Vaccination

Case

Sex

Age

Etiology

Time until onset

Symptoms

Positive lab and imaging findings

Effective treatment and course

All 11 cases of vaccine-associated AIE in the literature and their associated characteristics are reported and described. Of note, other cases have been reported, but not described within the literature [8, 16]. AIE: autoimmune encephalitis; COVID-19: coronavirus disease 2019; CSF: cerebrospinal fluid; EEG: electroencephalogram; IVIG: intravenous immunoglobulin; LP: lumbar puncture; NMDAR: N-methyl-D-aspartate receptor; PLEX: plasmapheresis; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; WBC: white blood cell.

Coecklebergh and Reynders, 2021 [7]

Yellow fever vaccine

2 to 3 days post-vaccination

Systemic, neurological, movement, autonomic

Anti-NMDA antibodies in serum and CSF. LP: WBC 1 cell/µL, protein 54 mg/dL

Spontaneous remission after 3 weeks with no intervention

Hozakova et al, 2018 [8]

Yellow fever vaccine

27 days post-vaccination

Systemic, neurological, psychiatric

Anti-NMDAR antibodies in serum and CSF. EEG: slow wave delta activity.

Hofmann et al, 2011 [9]

Tetanus diphtheria pertussis and polio vaccine (TdaP-IPV)

1 day post-vaccination

Systemic, psychiatric, movement, neurological, autonomic

Anti-NMDAR antibodies in serum and CSF

Wang, 2017 [10]

Japanese encephalitis vaccine

14 days post-second dose of JE vaccination

Systemic, psychiatric, neurological, movement

Anti-NMDAR antibodies in CSF

IVIG

Abu-Abaa et al, 2022 [11]

mRNA COVID-19 vaccine

1 day post-vaccination

Neurological, psychiatric

LP: WBC 9 cells/µL, 62% lymphocytes, protein 76 mg/dL, glucose 75 mg/dL.
Myelin basic protein 29.6 ng/mL.

Complete resolution over 5-day hospitalization without active intervention.

Sluyts et al, 2022 [12]

mRNA COVID-19 vaccine

6 days post-vaccination

Psychiatric, neurological

LP: WBC 34 cells/µL, 95% lymphocytes, protein 107 mg/dL.

Complete resolution over 1 week of hospitalization without active intervention.

Peraita-Adrados and Bravo-Quelle, 2024 [13]

mRNA COVID-19 vaccine

7 weeks post-vaccination

Systemic, neurological, psychiatric, autonomic

Positive SARS-CoV-2 antigen test. LP: highly elevated protein and lymphocytic pleocytosis. Diffusion weighted MRI showed high signal in left hemisphere involving cerebral cortex, temporal, and frontal lobes.

Six cycles of PLEX with daily 1 g corticosteroid, followed by steroid taper.

Takata et al, 2021 [14]

ChAdOx1 nCoV-19 vaccine

A few days post-vaccination

Systemic, neurological, psychiatric

LP: WBC 18 cells/µL, 100% lymphocytes, IgG oligoclonal bands.

Olanzapine, with continued maintenance dose and follow-up as she has not fully recovered post-discharge.

Zuhorn et al, 2021 [15]

ChAdOx1 nCoV-19 vaccine

5 days post-vaccination

Neurological

LP: WBC 46 cells/µL.
EEG: diffuse abnormally slow theta rhythms.

10 mg dexamethasone with significant improvement.

Zuhorn et al, 2021 [15]

ChAdOx1 nCoV-19 vaccine

6 days post-vaccination

Neurological, psychiatric, movement

LP: WBC 115 cells/µL.
EEG: diffuse abnormally slow theta rhythms.

5 g methylprednisolone over 5 days led to immediate improvement.

Zuhorn et al, 2021 [15]

ChAdOx1 nCoV-19 vaccine

8 days post-vaccination

Systemic, neurological

LP: WBC 7 cells/µL.

Steroid immunotherapy rejected by patient, complete resolution over several weeks.