Triumph Over Adversity: A Case Report on Early Diagnosis and Effective Treatment of Progressive Acute Transverse Myelitis in the COVID-19 Era

Abstract

Introduction: Acute Transverse Myelitis (ATM) is a rare acute inflammatory disease. Currently, there are no data on the incidence rates in China or other Asian countries. ATM can occur due to various causes, including infections, autoimmune diseases, and demyelinating diseases. The incidence of ATM related to COVID-19 is even rarer, with few reports available. The aim of the current study is to report a rare case of transverse myelitis during COVID-19 infection. Case presentation: A 65-year-old male patient developed fever, cough, and fatigue on December 25, 2022, and tested positive for COVID-19. After self-medicating, his fever subsided, but he soon experienced chest tightness and abdominal discomfort. Admitted to the emergency department on January 2, 2023, he quickly developed muscle weakness in his lower limbs, progressing to severe weakness (1/5 strength) and urinary retention. This weakness extended to his upper limbs, reducing his strength to 3-/5 and impairing his ability to use a mobile phone. Numbness also spread to his navel area. A positive Babinski sign was noted five days later. He showed significant improvement following timely diagnosis and pulse glucocorticoid therapy. Discussion: Research increasingly recognizes ATM as a neurological complication of COVID-19, though the exact mechanism of SARS-CoV-2 causing ATM is unclear. The virus may affect the spinal cord through direct invasion, cytokine storms, or autoimmune responses. ATM rapidly progresses and can cause multi-organ failure if untreated. Conclusion: No specific treatment or standard protocol exists for ATM, but corticosteroid pulse therapy, especially with methylprednisolone, has been effective in treating ATM by promoting nerve conduction and restoring neurological function.