SHM Converge Scientific Abstract ePoster Gallery-From Flu to Fall to Paralysis: An Unexpected Case of Post-Influenza Transverse Myelitis

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This case describes a 78-year-old man who was previously independent and ambulatory, presenting initially with 2 days of fever, malaise, and cough. He tested positive for Influenza A and was discharged with oseltamivir. He was later recalled to the ED after blood cultures grew Kocuria marina.<br /><br />During hospitalization, he initially appeared well and was walking without assistance. On hospital day 2, he fell and was found to have decreased lower-extremity strength. By the next day, he developed rapid progression to severe bilateral leg weakness, urinary retention, and decreased rectal tone. An urgent MRI showed diffuse spinal cord signal abnormality and slight cord expansion extending from C7 to the conus medullaris, consistent with longitudinally extensive transverse myelitis. Lumbar puncture revealed elevated white blood cells and protein, supporting an inflammatory process.<br /><br />He was treated with high-dose methylprednisolone followed by plasma exchange. Repeat blood cultures were negative, and follow-up MRI at day 30 showed near-complete resolution of cord swelling. Despite radiographic improvement and early treatment, he had no meaningful neurologic recovery and remained paraplegic with urinary retention at discharge to rehabilitation.<br /><br />The report highlights transverse myelitis as a rare complication of Influenza A. It also emphasizes risk factors for persistent disability: older age, infectious antecedent, rapid onset, and peripheral nervous system involvement. This patient had all four, which may explain his poor functional outcome despite good baseline health and prompt treatment.

Asset Subtitle

Jessica Cristallo

Meta Tag

Author List Jessica Cristallo, Sadia Alam

Category Clinical Vignettes

Concept Longitudinally Extensive Transverse Myelitis

Concept Transverse Myelitis

Concept Influenza A

Concept Magnetic Resonance Imaging

Concept Persistent Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Jessica Cristallo

Track Adult

Keywords

Influenza A

transverse myelitis

longitudinally extensive transverse myelitis

paraplegia

urinary retention

spinal cord inflammation

Kocuria marina

methylprednisolone

plasma exchange

neurologic disability

Longitudinally Extensive Transverse Myelitis

Transverse Myelitis

Influenza A

Magnetic Resonance Imaging

Persistent Neurologic Deficit