Drug Points

Transverse myelitis after measles, mumps, and rubella vaccine

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7002.422a (Published 12 August 1995) Cite this as: BMJ 1995;311:422
  1. K A Joyce,
  2. J E Rees

    Drs K A JOYCE and J E REES (Hurst-wood Park Neurological Centre, Haywards Heath, West Sussex RH16 4EX) write: A 20 year old man who planned to work with children in the United States was instructed to be vaccinated against rubella and was given measles, mumps, and rubella vaccine. Five days later he developed fever, malaise, sore throat, and a transient rash over his upper body. These symptoms fluctuated over the next two weeks, after which he developed urinary retention, followed by an ascending paraesthesia. On admission to hospital he had a rapidly progressive flaccid paraplegia, with sensory loss below T1 and loss of anal tone. He was feverish and remained so for 36 hours.

    Full blood count and erythrocyte sedimentation rate were normal. Analysis of cerebrospinal fluid showed a clear and colourless fluid containing 370x106 white cells (80% lymphocytes), 207x106 red cells, 1.8 mg/l protein, and 3.0 mmol/l glucose (serum glucose concentration 4.3 mmol/l). Gram staining was negative. Viral organisms were not found in cerebrospinal fluid or throat swabs. Serological tests for Epstein-Barr, mumps, measles, and rubella viruses showed a significant rise in titres of rubella antibodies only (from 30 IU to 240 IU for IgG and from positive to strongly positive for IgM). Radiology of brain and spinal cord, including magnetic resonance imaging, gave normal results. Visual evoked potentials were within normal limits.

    Postvaccination transverse myelitis was diagnosed, and the patient was treated with intravenous steroids for five days. Improvement was only limited and he had remained paralysed below T6.

    To our knowledge, only three cases of possible myelitis after rubella vaccination have been described.1 2 3 Little is known about the pathogenesis of postvaccination transverse myelitis, and we have no information to suggest that the risk increases with concurrent administration of other live viruses, or in those already immune. Antibody status should be checked before immunisation and, if possible, only the required vaccine should be given.

    References

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