SHM Converge Scientific Abstract ePoster Gallery-A Case of Longitudinally Extensive Transverse Myelitis Following a Breakthrough Covid-19 Infection

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This poster reports a rare case of longitudinally extensive transverse myelitis (LETM) occurring after a breakthrough COVID-19 infection in a vaccinated patient. A 66-year-old man with hypertension developed progressive weakness starting in both legs and later involving the hands, along with tingling and sensory loss. He had received the Moderna mRNA vaccine one month before symptom onset and then developed COVID-19 infection 15 days later.<br /><br />On examination, he had severe lower-extremity weakness, mild upper-extremity weakness, and decreased vibration and position sense in the feet. Routine labs were mostly normal. MRI of the cervical and thoracic spine showed long segments of increased T2 signal in the lateral corticospinal tracts extending to T12, consistent with LETM. Cerebrospinal fluid testing and autoimmune/paraneoplastic workup, including AQP4 and MOG antibodies, were negative. He was treated with plasma exchange and had partial improvement.<br /><br />The authors note that COVID-19 can cause a range of neurological complications, including encephalitis, stroke, Guillain-Barré syndrome, and inflammatory spinal cord disorders. LETM is a rare form of transverse myelitis affecting three or more vertebral segments, and only a few cases have been reported after COVID-19 infection. This case is notable because LETM appeared after a breakthrough infection despite recent mRNA vaccination.<br /><br />The report suggests the myelitis was likely post-infectious, though a combined effect of vaccination and infection cannot be excluded. Proposed mechanisms include direct viral effects through ACE2 receptors and immune-mediated injury from cytokine-driven inflammation damaging myelin. The case emphasizes that, although vaccination reduces severe COVID-19 outcomes, rare serious neurological complications may still occur after breakthrough infection.

Asset Subtitle

Shivaraj Nagalli

Meta Tag

Author List Nidhi Kikkeri, Shivaraj Nagalli

Category Clinical Vignettes

Concept Longitudinally Extensive Transverse Myelitis

Concept Myelitis

Concept Total Plasma Exchange

Concept Breakthrough COVID-19 Infection

Concept Neurologic complication

Distinguished Non-Finalist

Presenter Organization Brookwood Baptist Health

Presenting Author Shivaraj Nagalli

Track Adult

Keywords

longitudinally extensive transverse myelitis

LETM

COVID-19 infection

breakthrough infection

Moderna mRNA vaccine

transverse myelitis

spinal cord inflammation

plasma exchange

neurological complications

AQP4 and MOG antibodies

Longitudinally Extensive Transverse Myelitis

Myelitis

Total Plasma Exchange

Breakthrough COVID-19 Infection

Neurologic complication