A 69-year-old otherwise healthy woman presented to our clinic with irradiated cervical pain, imbalance, and motor weakness and numbness in the left hand, which had been ongoing for 7 days. Eight days before the onset of these symptoms, she had fever and dry cough. On admission, her neurologic examination showed right facial and left hand hypoesthesia, subtle left hand interosseous weakness, and general hyperreflexia. MRI of the brain was normal, whereas spinal cord images (figure 1, A and D) showed T2hyperintensity extending from the medulla oblongata to C7, involving most of the cord with diffuse patchy enhancing lesions, suggesting acute transverse myelitis. Extensive diagnostic workup was performed, showing negative results in blood test for infectious, autoimmune diseases (including myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies), and other potential causes such as vitamin deficits or antiphospholipid syndrome.