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Post-COVID-19 longitudinally extensive transverse myelitis: is it a new entity?
Doruk Arslan1, Pinar Acar-Ozen2, Rahsan Gocmen3
1Department of Neurology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey. dorukarslan@hacettepe.edu.tr.
Summary
Two men developed transverse myelitis weeks after COVID-19 infection. This post-infectious neurological complication, possibly due to immune overreaction, showed atypical presentations and responded to treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Presents two cases of post-COVID-19 longitudinally extensive transverse myelitis (LETM).
- Highlights atypical presentations of LETM following SARS-CoV-2 infection.
- Suggests a post-infectious etiology linked to immunogenic overreaction.
Observation:
- Two male patients, aged 44 and 73, presented with transverse myelitis symptoms 3-4 weeks post-COVID-19 resolution.
- Neurological examination revealed paraplegia and urinary-fecal incontinence.
- Spinal MRI confirmed LETM in both patients, affecting thoracic segments and conus medullaris.
Findings:
- No significant diagnostic markers were identified.
- The clinical presentation suggests a secondary immunogenic overreaction to COVID-19.
- Long lag times between infection and neurological symptoms were observed.
Implications:
- Post-infectious myelitis following COVID-19 may present atypically.
- Treatment with methylprednisolone, IV immunoglobulin, and plasmapheresis led to patient improvement.
- Further research is needed to understand if post-COVID-19 myelitis differs from other viral-induced myelitis.
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