case_images: PMC10467250_01
case_images: Timeline of events. Green bars represent time, moving left to right. Scale bar ("1 month") refers to right-hand segment centered around the acute illness ("event," pink highlighting); scale in left-hand time segments is compressed. Following diagnosis of mild Alzheimer's disease, ~4 years prior to the event, the patient tested negative for variants in 27 genes (Adult Neurodegenerative Disease panel, Invitae), including APP, PSEN1, and PSEN2. At no time has she been treated with cholinesterase inhibitors or memantine. Participation in the open-label extension trial of aducanumab (NCT04241068) began about a year and half before the event; "infusion months" refer to that trial. Thirty days before the event, PCR-based test for SARS-CoV-2, obtained for international travel, was negative. A 2-week illness with very abrupt onset began 4 h following the vaccinations. The patient reported, "I lost 2 weeks of my life." She has clear memory of the acute onset but little recollection of the first week of illness. Regarding the second week, she said "I was in a fog." Prednisone, 1 mg/day, was continued throughout the 2-week episode and for several days thereafter, completing 1-year tapering course for PMR. Aducanumab was administered (infusion #20) on day 10 after acute onset, the same day that bloodwork showed elevated GGT and alkaline phosphatase. Brain MRI on this day showed no evidence of ARIA-E, but the next two infusions (#21, #22) were held because of ARIA-E. Shortly thereafter and more than a month following resolution of the post-vaccine acute illness, PMR recurred, less severe than the episode that started a year earlier.. AD: Alzheimer's disease; Alk Phos: alkaline phosphatase; ARIA-E: amyloid-related imaging abnormalities-edema; GGT: gamma-glutamyl transferase; N/V: nausea and vomiting; PCR: polymerase chain reaction; Ph 3: phase 3; PMR: polymyalgia rheumatic; wks: weeks; X: fold increase over the top of the normal range of blood levels; yo: years old; yr: year.
case_images: 10.1177_2050313X231194507-fig1.jpg
case_images: PMC10467250_01_10.1177_2050313X231194507-fig1.jpg
case_images: fig1-2050313X231194507
case_images: A woman in her seventies had a 2-week episode of flu-like symptoms with cholangitis starting several hours after receiving SARS-CoV-2 booster and influenza vaccines (detailed timeline, Figure 1).
case_images: PMC10467250_02
case_images: PMC10467250_03
case_images: PMC10467250_04