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Plasmapheresis in post-COVID-19 myelitis: A case report
Witoon Mitarnun1, Lisa Kongngern1, Praewa Tantisungvarakoon2
1Neurology Unit, Department of Internal Medicine, Buriram Hospital, Buriram, Thailand
Insights
Plasmapheresis shows promise in treating myelitis following coronavirus disease 2019 (COVID-19) infection. This treatment improved neurological symptoms in a vaccinated patient with prolonged post-COVID-19 myelitis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Neurological complications, including myelitis, can arise from coronavirus disease 2019 (COVID-19).
- Limited data exists on effective treatments for post-COVID-19 myelitis.
- Myelitis is a rare but serious neurological complication of COVID-19.
Purpose of the Study:
- To report a case of myelitis following COVID-19 infection in a vaccinated individual.
- To evaluate the efficacy of plasmapheresis in treating prolonged COVID-19-related myelitis.
Main Methods:
- A case report of a 61-year-old male patient with post-COVID-19 myelitis.
- The patient experienced progressive lower-extremity weakness, sensory deficits, and urinary retention after a mild COVID-19 infection.
- Treatment involved methylprednisolone followed by five cycles of plasmapheresis.
Main Results:
- Initial treatment with methylprednisolone did not yield clinical improvement.
- Following plasmapheresis, the patient showed significant recovery in muscle strength (from 2/5 to 4/5).
- Sensory and urinary symptoms resolved after plasmapheresis treatment.
Conclusions:
- COVID-19 infection may trigger myelitis, even in vaccinated individuals.
- Plasmapheresis appears to be a promising therapeutic option for prolonged COVID-19-related myelitis.
- This case highlights the potential benefits of plasmapheresis in managing severe neurological sequelae of COVID-19.
Background:
Previous studies have delineated different neurological manifestations associated with coronavirus disease 2019 (COVID-19). Myelitis is identified as a rare neurological complication resulting from a COVID-19 infection. Limited information is available regarding the treatment of patients experiencing this condition.
Case Report:
This report extracts data from the medical record of a post-COVID-19 myelitis patient at Buriram Hospital and follows up prospectively on the patient's symptoms after treatment. A 61-year-old man, previously vaccinated for COVID-19 and with a history of hypertension and dyslipidemia, experienced progressive bilateral lower-extremity weakness (recorded as muscle strength grade 2/5 in both lower extremities) for 6 weeks. He had a mild case of COVID-19 2 months earlier, which resolved in 10 days without specific treatment. However, 2 weeks after being diagnosed with COVID-19, he developed weakness in his lower limbs, numbness below the nipple, and urinary retention. Spinal magnetic resonance imaging revealed multifocal longitudinal myelitis. Despite initial treatment with methylprednisolone, the patient showed no clinical improvement. Consequently, he underwent five cycles of plasmapheresis. Three months after discharge, a notable improvement was observed, with his muscle strength graded at 4/5 in both lower extremities and the resolution of sensory and urinary symptoms.
Conclusions:
We presented the case of a COVID-19-vaccinated patient, in whom COVID-19 infection might have led to myelitis. We found promising results in treating prolonged COVID-19-related myelitis symptoms through the use of plasmapheresis.
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