A Case Report of Acute Transverse Myelitis Following Novel Coronavirus Infection

Abstract

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, emergency providers are not only seeing an increasing number of patients with COVID-19 infections, but also associated complications and sequelae of this viral illness. Case Report: We present the case of a 28-year-old female patient who presented after a confirmed COVID-19 infection with lower back pain, bilateral symmetric upper and lower extremity numbness, and urinary retention. The patient was diagnosed with acute transverse myelitis. She required intravenous corticosteroids and plasma exchange with significant improvement in symptoms and minimal residual effects. Conclusion: This case illustrates the importance of prompt recognition and treatment of sequelae of COVID-19 infections.

Case Report: Acute Spinal Cord Myelopathy in Patients With COVID-19

“…They postulated focal myelitis but without MRI imaging or serological confirmation. The second case was in Boston where a 28-year-old female with a history of hypothyroidism and treatment with levothyroxine developed symptoms of productive cough and low-grade temperature followed by acute myelitis 7 days later ( 4 ). In the third case, Munz et al ( 3 ) reported a 60-year-old patient with acute onset moderate spastic paraparesis with retention of urine.…”

“…However, spinal cord involvement seems to be rare in COVID-19. To our knowledge, only a few case reports have been published (2)(3)(4)(5).…”

Neurological manifestations of coronavirus disease 2019: exploring past to understand present

“…Vascular • Ischemic stroke [ 23 ] • Ischemic stroke[ 1 ] • Ischemic stroke with large vesselocclusion [ 11 , 24 ] • Intracerebral hemorrhage,subarachnoidhemorrhage [ 25 , 26 ] • CVST [ 27 – 29 ] • PRES [ 30 – 33 ] • Microvascular occlusivedisorder [ 34 ] 3. Immunological • ADEM [ 35 ] • MS like illness [ 35 – 38 ] • ADEM[ 15 ] • Post infectious ADEM [ 38 , 39 ] • Acute transverse myelitis [ 40 – 43 ] • Anti-NMDA encephalitis [ 44 ] • Generalized and diaphragmaticmyoclonus [ 45 , 46 ] • Opsoclonus and ocularflutter [ 47 ] 4. Extrapyramidal features • Parkinsonism [ 48 ] • Parkinsonism [ 49 , 50 ] 5.…”

“…None of these cases manifested features related to cerebrum, optic nerve, cerebellar pathways, or brainstem involvement. Three of them developed neurological symptoms in the second week of illness, with the fourth case manifesting on the 3rd day of illness [ 40 – 43 ]. MRI study revealed longitudinally extensive transverse myelitis involving the entire length of cord in first two [ 40 ], multifocal transverse myelitis in third [ 42 ], and brainstem involvement in the fourth case [ 40 ].…”

“…Although SARS-CoV-2 could not be detected in CSF examination, it revealed lymphocytic pleocytosis with hyperproteinorrachia in one of the four cases [ 42 ]. Relevant autoimmune panel in serum and CSF and serological screening for neurotropic viruses were negative [ 40 , 42 , 43 ]. Considering the onset of myelitis symptoms in the second week of illness along with significant response to immunomodulation, immune-mediated pathology appears likely in these cases [ 43 ].…”