The BNT162b2 (Pfizer BioNTech) mRNA vaccine is an effective vaccine against COVID-19 infection. Here, we report an adverse event following immunization (AEFI) in a 48-year-old female patient who presented with fasciculations, migraine auras without headaches and in an increased discomfort of previously present palpitations, as well as excitation and insomnia. Her fasciculations were intermittently present until the time this paper was written, starting from the 6th day post-vaccination; they changed localization and frequency, but most commonly they were generalized, affecting almost all muscle groups. The patient also suffered from two incidents of migraine auras with visual kaleidoscope-like phenomena without headaches a few months after the vaccination. These symptoms were considered to be AEFI and no causal relation with the vaccine could be proven.

Introduction: Avelumab is a programmed death ligand 1–blocking monoclonal antibody used for the treatment of Merkel cell carcinoma (MCC), urothelial carcinoma, and other solid tumors. It acts as an immune checkpoint inhibitor and prolongs survival of MCC patients. Immune-mediated neurological adverse effects are rare and usually respond well to specific therapy. Methods and Results: A case of a 70-year-old man with metastatic MCC is described in this study. The patient developed diplopia after the fourth dose of avelumab, which was then discontinued. Seven months later, therapy was reinitiated and followed by a new adverse neurological event: severe demyelinating polyneuropathy combined with ophthalmoplegia refractory to a plethora of immune suppressive/modulatory treatment regimes. Discussion: This report of severe demyelinating polyneuropathy and cranial neuropathy associated with an anti–programmed death ligand 1 drug refractory to immune suppressive/modulatory treatments sheds a new light to evolving spectrum of immune checkpoint inhibitor immune-related neurological adverse events.

Background: Tuberous sclerosis is a rare, genetic disease with the various clinical presentations with most frequent clinical presentation which includes epileptic seizures and cognitive disorders. The main cause of mortality in those group of patients is renal impairment., and in some cases, neurological and renal clinical manifestation can be followed, but can also be the main therapeutic aim of mTOR inhibitors. Here, we aimed to correlate neurological symptoms with different stages of chronic kidney disease. Methods: This multicentric retrospective study included 51 patients from clinical centres from seven South-Eastern Europe countries We included patients older then 18 years with possible or definitive diagnosis of TSC. Data were collected from nephrological and neurological registries form clinical centres. Results: Study enrolled 51 patients with a median age of 32.3 years and predominant female gender. Neurological symptoms represented with epiletic sizures were more common in patients in earlier stages of CKD (nonESRD patients) then in patients in the end-stage renal disease. Conclusion: Results of this study have shown that neurological manifestation in analyzed cohort correlate with renal lesions in early stage of chronic kidney disease.