A Case of Acute Transverse Myelitis in a Mildly Symptomatic Patient: An Emerging and Serious Neurological Manifestation of COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is known to have neurological manifestations and one of them is acute transverse myelitis (ATM). Despite being exceedingly rare (1.34-4.6 cases per million/year), COVID-19-associated ATM cases have continuously been reported and have significant health impact to patients. This case report presents a previously healthy, unvaccinated male who developed COVID-19-associated ATM.

Acute Transverse Myelitis as a Neurologic Complication in an Asymptomatic COVID-19 patient

“…There are still no literature claiming transverse myelitis as the initial and lone presentation in an asymptomatic COVID-19 patient. There are some data on patients with transverse myelitis who have mild to moderate symptoms (Lingas, 2022;Qazi et al, 2021), or even after being clinically recovered from it (Quiles et al, 2022). Due to absence of other causation, we diagnosed this case as a post-COVID-19 acute transverse myelitis in patient without any signs and symptoms of COVID-19.…”

“…Furthermore, an immune-mediated injury would likely produce autoantibodies through molecular mimicry. Lastly, the virus can induce cytokine storms, which increases cytokine levels and activates complement, macrophages, T cells and endothelial cells (Beh et al, 2013;Lingas, 2022;Qazi et al, 2021;Schulte et al, 2021) Majority of the COVID 19-associated acute transverse myelitis reported before was able to meet the criteria presented by the Transverse Myelitis Consortium Working group such as clinical evidence of motor or sensory symptoms bilaterally, or autonomic dysfunction due to a spinal cord lesion, and MRI confirmation (Román et al, 2021). Our patient presented with paraparesis, sensory level deficit, and bladder dysfunction, and with MRIconfirmed images of a longitudinally extensive lesion.…”