Immunoglobulins are beneficial in SARS-CoV-2 vaccine-induced small fibre neuropathy even 3 years after onset

SARS-CoV-2 vaccination (SC2V) can be complicated by post-acute COVID-19 vaccination syndrome (PACVS). One manifestation of PACVS is small fibre neuropathy (SFN). A positive effect of intravenous immunoglobulins (IVIGs) even 3 years after the onset of PACVS is not known. The patient is a 52-year-old woman who developed PACVS after the second BNT162b2 vaccination in June 2021, which manifested clinically with SFN, myopericarditis, coagulopathy, and ocular, dermatologic, immunologic, and central nervous system (CNS) abnormalities. The SFN itself manifested as sensory disturbances, arterial hypotension and postural tachycardia syndrome (POTS). After the patient received three cycles of IVIGs, starting in June 2024, three years after the onset of PACVS, there was a significant positive effect on her SFN and other symptoms, as evidenced by various specific investigations. This case demonstrates that symptoms and signs of SFN as a manifestation of PACVS may benefit from the administration of IVIGs even years after onset.