Covid-19 post-infectious acute transverse myelitis responsive to corticosteroid therapy: report of two clinical cases

Abstract

SARS-COV-2 infection has affected millions of individuals with a wide range of clinical manifestations, including central and peripheral nervous systems through several mechanisms. A rare but potentially severe manifestation of this virus is transverse myelitis. Herein, we report on two patients who developed paraparesis, sensory deficit, and autonomic changes on the tenth day after infection by COVID-19. A 27-year-old man, previously healthy, had symptoms of COVID-19 confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience acute paraparesis, urinary retention, constipation, and hypoesthesia up to the T4 level. The second patient is a 50-year-old man, previously healthy, who had symptoms of the flu-like syndrome. The diagnosis of COVID-19 infection was confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience paraparesis, urinary incontinence, and hypoesthesia up to the T6 level. The neuroimaging and cerebrospinal fluid (CSF) analysis of both patients confirmed acute transverse myelitis after COVID-19 infection. High-dose corticosteroid therapy was started, and both patients showed rapid recovery from their deficits. Although rare, post-infectious transverse myelitis may be related to SARS-COV-2 infection and should be quickly recognized. Although controlled studies are needed, treatment with corticosteroid therapy in high doses was effective in these patients.

Post Coronavirus Disease 2019 Vaccine-associated Acute Myeloradiculoneuropathy Responsive to Plasmapheresis

“…He returned to walking unassisted after 60 days with mild hypoesthesia in his left foot and mild urinary retention. Previous studies reported similar and worse outcomes after the COVID-19 vaccine and other viral infections 1,2 . Our report presents one of the earliest cases described after vaccination; however, it has already been registered at a similar time 3 .…”

Clinical Profile and Outcomes of COVID-19–Associated Transverse Myelitis

“…In the final review, 30 studies detailing 65 unique cases were included. 3-32 The search strategy is detailed in Figure 2. The selected studies are summarized in eTable 1 (links.lww.com/CPJ/A380).…”

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

“…Apart from the medical therapy, our patient also underwent extensive rehabilitation at home, which also aided in her faster recovery. It has been shown that rehabilitation of post-transverse myelitis patients could help in generating the process of central plasticity and sensorimotor reprogramming (Vasconcelos et al, 2021).…”