Acute transverse myelitis (ATM) associated with COVID 19 infection and vaccination: A case report and literature review

Srinivas Medavarapu; Nitasha Goyal; Yaacov Anziska; Srinivas Medavarapu; Nitasha Goyal; Yaacov Anziska

doi:10.3934/Neuroscience.2024011

AIMS Neuroscience

2024, Volume 11, Issue 2: 178-187. doi: 10.3934/Neuroscience.2024011

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Case report

Acute transverse myelitis (ATM) associated with COVID 19 infection and vaccination: A case report and literature review

1.
Department of Neurocritical care, Mount Sinai and and Department of Neurology, State University of New York Downstate, Brooklyn, NY, USA
2.
State University of New York Downstate Medical School, Brooklyn, NY, USA
3.
Department of Neurology, Neuromuscular Disease, State University of New York Downstate, Brooklyn, NY, USA

Received: 01 December 2023 Revised: 27 May 2024 Accepted: 03 June 2024 Published: 11 June 2024

Acute transverse myelitis (ATM) is an inflammatory disorder caused by many etiologies, from postinfectious to autoimmune. Rarely, ATM cases have been reported after both COVID-19 infection and COVID-19 vaccination. We described our experience with ATM after COVID-19 infection and conducted a literature review.
Case finding Methods
We reported a case of longitudinally extensive ATM after COVID 19 infection, who also received convalescent plasma therapy, and present a comprehensive literature review of ATM cases reported after COVID-19 infection and COVID-19 vaccination. The literature search was done using PubMed and Google scholar with keywords and selected peer-reviewed articles. The search included all cases from Jan 2020 to Sept 2022.
Results
A total of 60 ATM cases reported association with post COVID 19 infection, and 23 ATM cases reported association with post COVID 19 vaccinations. Among post COVID 19 ATM cases, the mean age was 49 years and the youngest reported was 7-month-old. A total of 55% (33) were longitudinally extensive ATM. The most common symptom was lower extremity weakness. One case was reported as necrotizing myelitis on biopsy, and another case overlapped with syndrome of GBS and longitudinal ATM. No cases reported using convalescent plasma therapy after infection. Almost all the ATM cases were treated with steroids, but some cases needed additional treatment since not all responded adequately. Six cases (10%) responded with steroids plus plasmapheresis, and 5 cases (8%) responded with steroids + IVIG, especially in the pediatric age group. One case reported a positive response after treatment with eculizumab, and another with infliximab. Two cases (3%) remained paraparetic. Among post covid-19 vaccine ATM cases, 4 cases (17%) were reported as longitudinally extensive ATM. Five cases (21%) had symptom onset within a week after vaccination. Almost all reported a response to steroids except for one case which reported fatality after the 58^th day after vaccination.
Conclusion
ATM, in the setting of acute COVID-19 infection, has been described in multiple cases and is a rare complication of COVID-19 vaccination.
- COVID-19,
- Transverse Myelitis
Citation: Srinivas Medavarapu, Nitasha Goyal, Yaacov Anziska. Acute transverse myelitis (ATM) associated with COVID 19 infection and vaccination: A case report and literature review[J]. AIMS Neuroscience, 2024, 11(2): 178-187. doi: 10.3934/Neuroscience.2024011

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Abstract

Acute transverse myelitis (ATM) is an inflammatory disorder caused by many etiologies, from postinfectious to autoimmune. Rarely, ATM cases have been reported after both COVID-19 infection and COVID-19 vaccination. We described our experience with ATM after COVID-19 infection and conducted a literature review.

Case finding Methods

We reported a case of longitudinally extensive ATM after COVID 19 infection, who also received convalescent plasma therapy, and present a comprehensive literature review of ATM cases reported after COVID-19 infection and COVID-19 vaccination. The literature search was done using PubMed and Google scholar with keywords and selected peer-reviewed articles. The search included all cases from Jan 2020 to Sept 2022.

Results

A total of 60 ATM cases reported association with post COVID 19 infection, and 23 ATM cases reported association with post COVID 19 vaccinations. Among post COVID 19 ATM cases, the mean age was 49 years and the youngest reported was 7-month-old. A total of 55% (33) were longitudinally extensive ATM. The most common symptom was lower extremity weakness. One case was reported as necrotizing myelitis on biopsy, and another case overlapped with syndrome of GBS and longitudinal ATM. No cases reported using convalescent plasma therapy after infection. Almost all the ATM cases were treated with steroids, but some cases needed additional treatment since not all responded adequately. Six cases (10%) responded with steroids plus plasmapheresis, and 5 cases (8%) responded with steroids + IVIG, especially in the pediatric age group. One case reported a positive response after treatment with eculizumab, and another with infliximab. Two cases (3%) remained paraparetic. Among post covid-19 vaccine ATM cases, 4 cases (17%) were reported as longitudinally extensive ATM. Five cases (21%) had symptom onset within a week after vaccination. Almost all reported a response to steroids except for one case which reported fatality after the 58^th day after vaccination.

Conclusion

ATM, in the setting of acute COVID-19 infection, has been described in multiple cases and is a rare complication of COVID-19 vaccination.

Acknowledgments

None.

Funding

No funding or grant support.

Conflicts of interest

The following authors have no financial disclosures: NG, SM, SM, IL.

Authorship

All authors attest that they meet the current ICMJE criteria for Authorship.

References

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