Post-COVID-19 Longitudinally Extensive Transverse Myelitis with Myelin Oligodendrocyte Glycoprotein Antibodies

Yang, Ellen; Husein, Adnan; Martinez-Perez, Jose; Li, Terrence

doi:10.1155/2022/1068227

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…One patient was treated with intravenous immunoglobulins (IVIG) alone ( 33 ). One patient received IVMP+ IVIG ( 45 ), three received IVMP + PLEX ( 40 , 43 , 46 ), and three received IVMP+ PLEX+ IVIG ( 48 , 55 , 56 ). One patient was not treated ( 87 ).…”

Section: Resultsmentioning

confidence: 99%

COVID-19 and the risk of CNS demyelinating diseases: A systematic review

et al. 2022

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BackgroundViral infections are a proposed possible cause of inflammatory central nervous system (CNS) demyelinating diseases, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). During the past 2 years, CNS demyelinating events associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but causality is unclear.ObjectiveTo investigate the relationship between CNS demyelinating disease development and exacerbation with antecedent and/or concurrent SARS-CoV-2 infection.MethodsA systematic literature review of all publications describing either a new diagnosis or relapse of CNS demyelinating diseases (MS, NMOSD, MOGAD) in association with SARS-CoV-2 infection was performed utilizing PRISMA guidelines. Descriptive statistics were used for data analysis, using a case analysis approach.ResultsSixty-seven articles met the inclusion criteria for the study. Most of the reported cases of NMOSD (n = 13, 72.2% of reported cases) and MOGAD (n = 27, 96.5% of reported cases) were of new disease onset, presenting with typical clinical and radiographic features of these conditions, respectively. In contrast, reported MS cases varied amongst newly diagnosed cases (n = 10, 10.5% of reported cases), relapses (n = 63, 66.4%) and pseudo-relapses (n = 22, 23.2%). The median duration between COVID-19 infection and demyelinating event onset was 11.5 days (range 0–90 days) in NMOSD, 6 days (range−7 to +45 days) in MOGAD, and 13.5 days (range−21 to +180 days) in MS. Most cases received high-dose corticosteroids with a good clinical outcome.ConclusionBased upon available literature, the rate of CNS demyelinating events occurring in the setting of preceding or concurrent SARS-CoV-2 infection is relatively low considering the prevalence of SARS-CoV-2 infection. The clinical outcomes of new onset or relapsing MS, NMOSD, or MOGAD associated with antecedent or concurrent infection were mostly favorable. Larger prospective epidemiological studies are needed to better delineate the impact of COVID-19 on CNS demyelinating diseases.

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Section: Resultsmentioning

confidence: 99%

COVID-19 and the risk of CNS demyelinating diseases: A systematic review

et al. 2022

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“…As with non-COVID-19-related MOGAD, the most common presenting neurologic symptoms are blurry vision, dyschromatopsia, and eye pain consistent with ON (commonly bilateral), 2,[24][25][26][27][28][29] or extremity weakness, paresthesias, and urinary retention consistent with myelitis. [30][31][32][33] However, less commonly, patients can present with headache, altered mental status, or seizures. Pediatric patients may be more likely to present with seizures or altered mental status, with patients from two of the three reported cases of this clinical presentation being <3 years of age.…”

Section: Myelin Oligodendrocyte Glycoprotein Antibody-associated Diseasementioning

confidence: 99%

“…24 26 In the majority of reported cases, there are no unique OCBs identified in the CSF. 32 34 36 37…”

Section: Covid-19-related Neuroimmunologic Disorders Of the Cnsmentioning

confidence: 99%

“…29,30 MRI of the brain can be normal in some cases of ON or TM, 26,28,30 but often concurrently demonstrates periventricular, juxtacortical, or infratentorial demyelinating-appearing T2/FLAIR hyperintense lesions with or without associated contrast enhancement. 21,38,39 In most cases, CSF testing reveals a mild lymphocytic pleocytosis and elevated protein, 30,32,40 though in some cases the CSF can be normal. 24,26 In the majority of reported cases, there are no unique OCBs identified in the CSF.…”

Section: Myelin Oligodendrocyte Glycoprotein Antibody-associated Diseasementioning

confidence: 99%

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Central Nervous System Neuroimmunologic Complications of COVID-19

Holroyd

Conway

2023

Semin Neurol

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Autoimmune disorders of the central nervous system following COVID-19 infection include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune encephalitis, acute disseminated encephalomyelitis, and other less common neuroimmunologic disorders. In general, these disorders are rare and likely represent postinfectious phenomena rather than direct consequences of the SARS-CoV-2 virus itself. The impact of COVID-19 infection on patients with preexisting neuroinflammatory disorders depends on both the disorder and disease-modifying therapy use. Patients with MS do not have an increased risk for severe COVID-19, though patients on anti-CD20 therapies may have worse clinical outcomes and attenuated humoral response to vaccination. Data are limited for other neuroinflammatory disorders, but known risk factors such as older age and medical comorbidities likely play a role. Prophylaxis and treatment for COVID-19 should be considered in patients with preexisting neuroinflammatory disorders at high risk for developing severe COVID-19.

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“…SARS-CoV-2 induces autoantibodies possibly through molecular mimicry, causing multiple clinical outcomes. Anti-GAD-65 has also been associated with COVID-19 and has caused autoimmune encephalitis and transverse myelitis [ 8 , 9 ]. While anti-GAD-65 was not measured in our patient, autoantibodies likely led to the pathogenesis of achalasia.…”

mentioning

confidence: 99%