Acute Necrotizing Myelitis Associated with COVID-19

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Acute ascending hemorrhagic longitudinally extensive transverse myelitis is a rare, rapidly progressing inflammatory demyelinating disorder.
• COVID-19 infection has been associated with various neurological complications, including myelitis.

Observation:

• A 10-year-old unvaccinated female contracted COVID-19 and subsequently developed severe neck pain, motor weakness, and urinary dysfunction.
• Initial MRI revealed extensive spinal cord lesions, and CSF analysis showed elevated red blood cells and protein, with negative infectious and autoimmune workups.
• Despite treatment with methylprednisolone, immunoglobulin, and therapeutic plasma exchange, the patient experienced persistent symptoms and respiratory failure.

Findings:

• Follow-up MRI showed a hemorrhagic component, indicating acute necrotizing myelitis.
• Multiple treatment courses resulted in only mild improvement in motor and sensory function.
• The patient ultimately had a poor prognosis due to the disease's rapid and severe progression.

Implications:

• This case highlights a rare but severe neurological complication of COVID-19, emphasizing the need for heightened awareness.
• It underscores the challenges in treating acute necrotizing myelitis, even with aggressive multimodal therapy.
• Further research is needed to understand the pathogenesis and develop more effective treatments for post-COVID-19 myelitis.