Acute myelitis after SARS-CoV-2 infection: a case report

Zhao, Kang; Huang, Jucun; Dai, Dan; Feng, Yuwei; Li, Liming; Nie, Shuke

doi:10.1101/2020.03.16.20035105

Cited by 198 publications

(231 citation statements)

References 19 publications

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“…4 Another case report from China described acute myelitis as a complication of COVID-19 presenting with flaccid lower limb weakness and persistent fever; a lumbar puncture was not performed but the authors felt the likely cause of myelitis was a post-viral inflammatory process. 5 As illustrated with this unusual case of rhombencephalitis, with evidence for a wider multi-system inflammatory response and the development of neurological symptoms over time, it is important to be vigilant for late non-respiratory manifestations of COVID-19 infections.…”

Section: Discussionmentioning

confidence: 98%

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

et al. 2020

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A 40-year-old man developed acute brainstem dysfunction 3 days after hospital admission with symptoms of the novel SARS-CoV-2 infection (COVID-19). Magnetic resonance imaging showed changes in keeping with inflammation of the brainstem and the upper cervical cord, leading to a diagnosis of rhombencephalitis. No other cause explained the patient's abnormal neurological findings. He was managed conservatively with rapid spontaneous improvement in some of his neurological signs and was discharged home with continued neurology follow up.A 40-year-old never-smoker with minimum alcohol intake, originally from Nigeria and now settled in the UK with his family after moving here 7 years ago, attended the emergency department reporting a 10-day history of persistent fever and progressive dyspnoea on exertion while self-isolating at home during the COVID-19 crisis. He was on long-term treatment with ramipril and amlodipine for hypertension and on dorzolamide (a carbonic anhydrase inhibitor) with timolol maleate eye drops for closed angle glaucoma. He reported malaise, a new cough with yellow sputum and diarrhoea (non-bloody) over 3 days. There was no recent foreign travel or family history of medical conditions but he shared the concern that his wife was currently pregnant.On presentation, temperature was 38.4°C, heart rate regular at 86 beats/minute, blood pressure 129/83 mmHg; oxygen saturation 93% on room air as he was tachypnoeic at 32 breaths/minute. On auscultation, heart sounds were normal but there were bi-basal ABSTRACT Authors: A ST4 Respiratory Medicine, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK; B clinical fellow, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK; C consultant neurologist, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK; D consultant respiratory physician, The Shrewsbury and Telford Hospital NHS Trust, Telford, UKcrackles. There was no gross focal neurological deficit. Initial 12-lead electrocardiography showed sinus tachycardia and chest X-ray showed a right lower zone consolidation. Arterial blood gas on room air revealed hypoxia (PaO 2 8.77 kPa) with pH 7.432, PaCO 2 4.21 kPa, HCO 3-20.6 mmol/L, base excess 2.6 mmol/L, lactate 0.98 mmol/L. Haemoglobin was 139 g/L, white cell count 7.0 × 10 9 /L (lymphocytes 1.2 × 10 9 /L) and C-reactive protein (CRP) marginally raised at 50 mg/L, and similar slight increases were seen in serum gamma glutamyl transferase (GGT) 107 U/L (range 0-75) and alanine aminotransferase (ALT) 88 U/L (range 0-45), with other liver tests and urinary electrolytes within the normal ranges.

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Section: Discussionmentioning

confidence: 98%

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

et al. 2020

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“…Kang Zhao et al reported acute myelitis in a 66-year-old male form Wuhan city who presented with fever and body aches. 22 Mao and colleagues reported six case of CVA in their cohort of 214. 11 There were five ischemic and one case of hemorrhagic stroke.…”

Section: Acute Myelitismentioning

confidence: 99%

Neurological Manifestations and Complications of COVID-19: A Literature Review

Ahmad

Rathore

2020

Preprint

151

196

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The Coronavirus disease due to SARS-CoV-2 emerged in Wuhan city, China in December 2109 and rapidly spread more than 200 countries as a global health pandemic. There are more million confirmed cases and around 165,000 fatalities. The primary manifestation is respiratory and cardiac but neurological manifestations are being reported in the literature as case reports and case series. The most common reported symptoms to include headache and dizziness followed by encephalopathy and delirium. Among the complications noted are Cerebrovascular accident, Guillian barre syndrome, acute transverse myelitis, and acute encephalitis. The most common peripheral manifestation was hyposmia. It is further noted that sometimes the neurological manifestations can precede the typical features like fever and cough and later on typical manifestations develop in these patients. Hence a high index of suspicion is required for timely diagnosis and isolation of cases to prevent the spread in neurology wards. We provide a narrative review of the important manifestations and complications of Coronavirus reported in the global literature so far.

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“…Although as a cause of AFP has not been reported until now [5]. Yet, there was one study reported a post-infectious acute myelitis as probable COVID-19 complication [6].Here, we reported a very rare complicated case of early-onset ATM following a SARS-CoV-2 respiratory infection.…”

Section: Discussionmentioning

confidence: 70%

“…It was intriguing that ACE2 receptors were also expressed on the membrane of spinal cord neurons. Furtherly, suggesting that SARS-CoV-2 was implicated in acute myelitis by the speci c ACE2 receptors on the surface of spinal cord neurons [6].…”

Section: Discussionmentioning

confidence: 99%

“…respiratory infection which passed several diagnostic, therapeutic and rehabilitative challenges. We only found one study reported a post-infectious acute myelitis as probable COVID-19 complication[6].Because of the potential signi cant morbidity of the disease associated with poor neurologic outcome, experience gained from case reports is important. We believe that SARS-CoV-2 has a potential to produces different extra respiratory multi-systemic involvement as immune-mediated process and complexes, and this should be kept in mind whenever encounter a patient with acute onset of neurological manifestations, especially after microbial infections or vaccinations[6,19].…”

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confidence: 99%

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Acute Transverse Myelitis After SARS-CoV-2 Infection: A Rare Complicated Case of Rapid Onset Paraplegia in a Male Veteran 

Hazrati

Farahani

Asl

et al. 2020

Preprint

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Background: SARS-CoV-2 (COVID-19) is a new human pathogen, and currently, the world has been plagued by its pandemic and there are no specific treatment options, mostly affects the respiratory system, ranging from mild flu-like symptoms to severe acute respiratory syndrome (SARS), but extra respiratory multi-systemic involvement has also been reported.Case presentation: A 63-yr-old Caucasian male veteran (retired army colonel), known case of controlled Type 2 diabetes, chronic renal failure and ischemic heart disease, about 4 days after the onset of flu-like syndrome (with no trauma history) experienced loss of control over both lower limbs, absent sensation from the chest below with constipation and urinary retention. Due to world SARS-CoV-2 (COVID-19) outbreak, his nasopharyngeal specimen was tested for COVID-19 reverse transcription polymerase chain reaction (RT-PCR) and positive result obtained. Chest x-ray and HRCT suggested severe pulmonary involvement. Immediately, he was admitted at emergency ward, treated based national COVID-19 protocol and a series of diagnostic procedures were started up to find out the cause of his non-heterogeneous peripheral (spinal) neuromuscular manifestations. Brain CT scan and MRI were normal, but spinal MRI with gadolinium contrast agent showing extensive increased T2 signal involves central grey matter and dorsal columns, extension between C7 and T12 with linear sagittally oriented enhancement posteriorly within the cord in the mid and lower thoracic cord. The CSF specimen obtained from LP shown pleocytosis, positive RT-PCR for SARS-CoV-2 and elevated IgG index. Clinical presentations, MRI, CSF and laboratory findings, after ruled out the other numerous possible causes with specific methods, suggested the Acute Transverse Myelitis (ATM) as a probably complication of COVID-19 infection. Intravenous methylprednisolone and then human immunoglobulin was added to treatment regimen. At the end, complete resolution of dysaesthesia, urinary retention and constipation were achieved. After continuous and long respiratory and motor rehabilitation programs, he was discharged home asymptomatic. Conclusions: We believe that SARS-CoV-2 has a potential to produces different extra respiratory multi-systemic involvement as immune-mediated process and complexes, and this should be kept in mind whenever encounter a patient with acute onset of neurological manifestations, especially after microbial infections or vaccinations.

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Acute myelitis after SARS-CoV-2 infection: a case report

Cited by 198 publications

References 19 publications

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

Neurological Manifestations and Complications of COVID-19: A Literature Review

Acute Transverse Myelitis After SARS-CoV-2 Infection: A Rare Complicated Case of Rapid Onset Paraplegia in a Male Veteran

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Acute myelitis after SARS-CoV-2 infection: a case report

Cited by 198 publications

References 19 publications

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

Neurological Manifestations and Complications of COVID-19: A Literature Review

Acute Transverse Myelitis After SARS-CoV-2 Infection: A Rare Complicated Case of Rapid Onset Paraplegia in a Male Veteran&nbsp;

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Acute Transverse Myelitis After SARS-CoV-2 Infection: A Rare Complicated Case of Rapid Onset Paraplegia in a Male Veteran