Background: The cause and effect relationship between anti-HBV immunization using recombinant vaccine and the development of a neurological event, including flare-ups of multiple sclerosis, is a widely debated issue.
Case report: A previously asymptomatic 16-year-old girl was a hyper-responder to anti-HBV vaccine. Subsequent to a booster shot of anti-HBV recombinant vaccine, she developed regressive acute cervical transverse myelitis with intrathecal oligochonal IgG secretion and a hypersignal on the MRI T2 sequences of the cord.
Discussion: The distinction between a first episode of multiple sclerosis or post-vaccinal acute myelitis in this case will depend upon subsequent course, but this observation points out the very high level of persistent post-vaccinal immunization which can be acquired by a hyper-responder.