SHM Converge Scientific Abstract ePoster Gallery-Covid and Flu Vaccine-Associated Transverse Myelitis

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This case report describes a 78-year-old woman who developed transverse myelitis after receiving a bivalent Pfizer-BioNTech COVID-19 booster and Fluzone quadrivalent influenza vaccine six days before symptom onset. She had previously tolerated earlier Moderna and Pfizer COVID-19 vaccinations without complications and had no autoimmune history.<br /><br />She presented with one day of left leg weakness and numbness. Examination showed reduced strength in the left lower extremity, a positive Babinski sign, and decreased sensation across dermatomes. Initial workup was broadly negative, including inflammatory and autoimmune labs, brain MRI, and cerebrospinal fluid studies. The first thoracic MRI showed a nonspecific, non-enhancing T2 hyperintense lesion at T5-6.<br /><br />Her hospital course included only modest early improvement, followed by worsening function, urinary retention, and constipation. Repeat thoracic MRI on day 10 showed clearer pathologic contrast enhancement and signal abnormality at T5-6, supporting the diagnosis of transverse myelitis. Anti-MOG and anti-AQP4 antibodies were negative. She completed five days of high-dose intravenous methylprednisolone.<br /><br />At two-month follow-up, she was able to ambulate independently with a cane, though she had not returned to her prior baseline.<br /><br />The authors note that transverse myelitis is a rare inflammatory demyelinating disorder associated with autoimmune disease, infection, and occasionally vaccination. Because both vaccines were given together, a single trigger cannot be identified. They emphasize that MRI findings may initially be nonspecific and that repeat imaging can be important when clinical suspicion remains high. The report is notable because it may be the first documented case of transverse myelitis following the bivalent Pfizer-BioNTech booster.

Asset Subtitle

Alexandre Zaharia

Meta Tag

Author List Alexandre Zaharia, Caleb Murphy, Teresa Xiao

Category Clinical Vignettes

Concept Transverse Myelitis

Concept Limb Weakness

Concept Sensory Loss

Concept Magnetic Resonance Imaging

Concept Inflammatory Demyelinating Disorder

Distinguished Non-Finalist

Presenter Organization University of Chicago Medicine

Presenting Author Alexandre Zaharia

Track Adult

Keywords

transverse myelitis

Pfizer-BioNTech booster

bivalent COVID-19 vaccine

influenza vaccine

thoracic MRI

T5-6 lesion

demyelinating disorder

methylprednisolone

urinary retention

repeat imaging

Transverse Myelitis

Limb Weakness

Sensory Loss

Magnetic Resonance Imaging

Inflammatory Demyelinating Disorder