SHM Converge Scientific Abstract ePoster Gallery-Transverse Myelitis as a Delayed Complication of Sars-Cov-2 Antibody Production After Covid-19

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A 36-year-old man developed acute transverse myelitis (ATM) three months after a COVID-19 infection. He presented with two weeks of progressive numbness that spread from the right leg to the left, along with severe lower-extremity weakness, absent reflexes, and urinary and fecal retention. He had no recent gastrointestinal illness, stroke, or other obvious trigger.<br /><br />Evaluation showed normal bloodwork, negative COVID-19 PCR and antigen tests, but a positive SARS-CoV-2 antibody test. MRI of the spine revealed transverse myelitis at T6–T8, and MRI of the brain was normal. Lumbar puncture was negative for infectious, autoimmune, and oligoclonal band findings, with normal protein and glucose. Aquaporin-4 antibody testing was negative.<br /><br />He was treated with five days of intravenous methylprednisolone and seven days of plasmapheresis, and he required intermittent catheterization for urinary retention. He was discharged with home health physical therapy and outpatient neurology and rehabilitation follow-up.<br /><br />The authors conclude that this was likely a delayed, immune-mediated complication of prior SARS-CoV-2 infection rather than active infection. They note that while headache and dizziness are the most common neurologic symptoms of COVID-19, ATM has been reported in a small number of cases worldwide. Proposed mechanisms include hypoxic injury from pneumonia and immune-mediated damage from an overactive inflammatory response. In this case, no other cause of ATM was identified, making post-infectious COVID-19 antibody–related autoimmunity the most likely explanation.

Asset Subtitle

Kelvin Y. Soewono

Meta Tag

Author List Kelvin Y. Soewono, Lynda Chowdhury, Michael Sheffield

Category Clinical Vignettes

Concept Transverse Myelitis

Concept COVID-19 Infection

Concept Lower Extremity Weakness

Concept Bladder Dysfunction

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization Methodist Dallas Medical Center

Presenting Author Kelvin Y. Soewono

Track Adult

Keywords

acute transverse myelitis

COVID-19

SARS-CoV-2 antibody

post-infectious autoimmunity

spinal cord inflammation

paraplegia

urinary retention

plasmapheresis

methylprednisolone

neurologic complication

Transverse Myelitis

COVID-19 Infection

Lower Extremity Weakness

Bladder Dysfunction

Corticosteroids