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

[1]	Simone CG, Emmady PD (2023) Transverse Myelitis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559302/
[2]	Ackerman T (2021) Acute Transverse Myelitis (ATM): An Unexpectedly Frequent Complication of COVID-19. COVID-19, NEUROLOGY & NEUROSURGERY .
[3]	“WHO Coronavirus (COVID-19) Dashboard.”. World Health Organization . Available from: https://data.who.int/dashboards/covid19/data [Accessed 9 June 2023]
[4]	Sriwastava S, Tandon M, Podury S, et al. (2021) COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2. J Neurol 268: 4448-4478. https://doi.org/10.1007/s00415-021-10611-9
[5]	Bösel YL (2021) Neurological manifestations of COVID-19 – an approach to categories of pathology. Neurol Res Pract 3. https://doi.org/10.1186/s42466-021-00138-9
[6]	Roy D, Ghosh R, Dubey S, et al. (2021) Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic. Can J Neurol Sci 48: 9-24. https://doi.org/10.1017/cjn.2020.173
[7]	Liotta EM, Batra A, Clark JR, et al. (2020) Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol 7: 2221-2230. https://doi.org/10.1002/acn3.51210
[8]	Ahmad I, Rathore FA (2020) Neurological manifestations and complications of COVID-19: A literature review. J Clin Neurosci 77: 8-12. https://doi.org/10.1016/j.jocn.2020.05.017
[9]	Maury A, Lyoubi A, Peiffer-Smadja N, et al. (2021) Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris) 177: 51-64. https://doi.org/10.1016/j.neurol.2020.10.001
[10]	Li X, Raventós B, Roel E, et al. (2022) Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events: population based cohort and self-controlled case series analysis. BMJ 376: e068373. https://doi.org/10.1136/bmj-2021-068373
[11]	Garg RK, Paliwal VK (2022) Spectrum of neurological complications following COVID-19 vaccination. Neurol Sci 43: 3-40. https://doi.org/10.1007/s10072-021-05662-9
[12]	West TW, Hess C, Cree BA (2012) Acute transverse myelitis: demyelinating, inflammatory, and infectious myelopathies. Semin Neurol 32: 97-113. https://doi.org/10.1055/s-0032-1322586
[13]	Greenberg BM, Krishnan C, Harder R (2019) New onset transverse myelitis diagnostic accuracy and patient experiences. Mult Scler Relat Disord 30: 42-44. https://doi.org/10.1016/j.msard.2019.01.046
[14]	Maroufi SF, Behdani FN, Rezania F, et al. (2022) Longitudinally extensive transverse myelitis after Covid-19 vaccination: case report and review of literature. Hum Vaccin Immunother 18. https://doi.org/10.1080/21645515.2022.2040239
[15]	Mao L, Jin H, Wang M, et al. (2020) Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China. JAMA Neurol 77: 1-9. https://doi.org/10.1001/jamaneurol.2020.1127
[16]	Román GC, Gracia F, Torres A, et al. (2021) Acute Transverse Myelitis (ATM): Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol 12: 653786. https://doi.org/10.3389/fimmu.2021.653786
[17]	Hsiao Y-T, Tsai M-J, Chen Y-H, et al. (2021) Acute Transverse Myelitis after COVID-19 Vaccination. Medicina 57. https://doi.org/10.3390/medicina57101010
[18]	Voysey M, Clemens SAC, Madhi SA, et al. (2021) Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 397: 99-111. https://doi.org/10.1016/S0140-6736(20)32661-1
[19]	Eom H, Kim SW, Kim M, et al. (2022) Case Reports of Acute Transverse Myelitis Associated With mRNA Vaccine for COVID-19. J Korean Med Sci 37. https://doi.org/10.3346/jkms.2022.37.e52
[20]	Advani S, Hosseini SM, Zali A, et al. (2021) Transverse myelitis after SARS-CoV-2 infection: Report of two cases with COVID-19. Clin Case Rep 9: e05196. https://doi.org/10.1002/ccr3.5196
[21]	Qazi R, Memon A, Mohamed AS, et al. (2021) Post-COVID-19 Acute Transverse Myelitis: A Case Report and Literature Review. Cureus 13: e20628. https://doi.org/10.7759/cureus.20628
[22]	Brisca G, Sotgiu S, Pirlo D, et al. (2022) Longitudinally Extensive Transverse Myelitis (LETM) and Myopericarditis in a 7-Month-Old Child with SARs-CoV-2 Infection. Neuropediatrics 53: 61-64. https://doi.org/10.1055/s-0041-1732364
[23]	Alrubaye R, Bondugula V, Baleguli V, et al. (2022) A possible Guillain-Barré syndrome/transverse myelitis overlap syndrome after recent COVID-19. BMJ Case Rep 15: e246967. https://doi.org/10.1136/bcr-2021-246967
[24]	Arslan D, Acar-Ozen P, Gocmen R, et al. (2022) Post-COVID-19 longitudinally extensive transverse myelitis: is it a new entity?. Neurol Sci 43: 1569-1573. https://doi.org/10.1007/s10072-021-05640-1
[25]	Baghbanian SM, Namazi F (2021) Post COVID-19 longitudinally extensive transverse myelitis (LETM)-a case report. Acta Neurol Belg 121: 1875-1876. https://doi.org/10.1007/s13760-020-01497-x
[26]	Lu IF, Cornish JS, Ashok A, et al. (2022) Early SARS-CoV-2-associated acute transverse myelitis: A case for neurotropism?. J Intern Med 292: 679-683. https://doi.org/10.1111/joim.13542
[27]	Guada L, Cabrero FR, Baldwin NL, et al. (2022) Acute Ascending Necrotizing Myelitis After COVID-19 Infection: A Clinicopathologic Report. Neurol Clin Pract 12: e28-e32. https://doi.org/10.1212/CPJ.0000000000001175
[28]	Fonseca JP, Coelho A, Lourenço AC, et al. (2022) Longitudinally extensive transverse myelitis (LETM) secondary to SARS-CoV-2 infection: A recent reality in spinal cord injury rehabilitation. Clin Case Rep 10: e05876. https://doi.org/10.1002/ccr3.5876
[29]	Mbonu C, Molokwu N, Matelski A (2022) A COVID Constellation: A Case of Transverse Myelitis and Acquired von Willebrand Syndrome. J Consum Cult 10: 296-316. https://doi.org/10.1177/1469540518787584
[30]	Koc ER, Turan ÖF, Mengüç B (2022) Covid-19 Infection as a Possible Risk Factor for Longitudinally Extensive Transverse Myelitis!. Int J Neurosci 134: 193-196. https://doi.org/10.1080/00207454.2022.2098731
[31]	Prete S, McShannic JD, Fertel BS, et al. (2022) Acute Transverse Myelitis Progressing to Permanent Quadriplegia Following Covid-19 Infection. Am J Emerg Med 56: 391.e1-391.e3. https://doi.org/10.1016/j.ajem.2022.02.038
[32]	Quiles LEP, Tiongson JJA, Buensalido MJOV, et al. (2022) Transverse Myelitis as Neurologic Sequelae in a COVID-19 Recovered Patient. Neuroimmunol Rep 2: 100055. https://doi.org/10.1016/j.nerep.2022.100055
[33]	Kara S, Candelore T, Youssef P, et al. (2021) Evidence of Post-COVID-19 Transverse Myelitis Demyelination. Cureus 13: e19087. https://doi.org/10.7759/cureus.19087
[34]	Pourmoghaddas Z, Sadeghizadeh A, Tara SZ, et al. (2021) Longitudinally extensive transverse myelitis as a sign of multisystem inflammatory syndrome following COVID-19 infection: A pediatric case report. J Neuroimmunol 360: 577704. https://doi.org/10.1016/j.jneuroim.2021.577704
[35]	Chow CCN, Magnussen J, Ip J, et al. (2020) Acute transverse myelitis in COVID-19 infection. BMJ Case Rep 13: e236720. https://doi.org/10.1136/bcr-2020-236720
[36]	Khan E, Shrestha AK, Colantonio MA, et al. (2022) Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature. J Neurol 269: 1121-1132. https://doi.org/10.1007/s00415-021-10785-2
[37]	Erdem NŞ, Demirci S, Özel T, et al. (2021) Acute transverse myelitis after inactivated COVID-19 vaccine. Ideggyogy Sz 74: 273-276. https://doi.org/10.18071/isz.74.0273
[38]	Gao JJ, Tseng HP, Lin CL, et al. (2021) Acute Transverse Myelitis Following COVID-19 Vaccination. Vaccines (Basel) 9: 1008. https://doi.org/10.3390/vaccines9091008
[39]	Finsterer J (2022) SARS-CoV-2 vaccinations complicated by transverse myelitis. Hum Vaccin Immunother 18: 2057162. https://doi.org/10.1080/21645515.2022.2057162
[40]	Nguyen S, Bastien E, Chretien B, et al. (2022) Transverse Myelitis Following SARS-CoV-2 Vaccination: A Pharmacoepidemiological Study in the World Health Organization's Database. Ann Neurol 92: 1080-1089. https://doi.org/10.1002/ana.26494
[41]	Maroufi SF, Naderi Behdani F, Rezania F, et al. (2022) Longitudinally extensive transverse myelitis after Covid-19 vaccination: case report and review of literature. Hum Vaccin Immunother 18: 2040239. https://doi.org/10.1080/21645515.2022.2040239
[42]	Tan WY, Yusof Khan AHK, Mohd Yaakob MN, et al. (2021) Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report. BMC Neurol 21: 395. https://doi.org/10.1186/s12883-021-02427-x
[43]	Eom H, Kim SW, Kim M, et al. (2022) Case Reports of Acute Transverse Myelitis Associated With mRNssA Vaccine for COVID-19. J Korean Med Sci 37: e52. https://doi.org/10.3346/jkms.2022.37.e52
[44]	Nakano H, Yamaguchi K, Kawabata K, et al. (2022) Acute transverse myelitis after BNT162b2 vaccination against COVID-19: Report of a fatal case and review of the literature. J Neurol Sci 434: 120102. https://doi.org/10.1016/j.jns.2021.120102
[45]	Miyaue N, Yoshida A, Yamanishi Y, et al. (2022) Refractory Longitudinally Extensive Transverse Myelitis after Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination in a Japanese Man. Intern Med 61: 739-742. https://doi.org/10.2169/internalmedicine.8747-21
[46]	Shetty AJ, Rastogi A, Jha V, et al. (2022) Longitudinally extensive transverse myelitis following ChAdOx1 nCoV-19 vaccine. J Postgrad Med 68: 179-181. https://doi.org/10.4103/jpgm.jpgm_1047_21
[47]	Maroufi SF, Behdani FN, Rezania F, et al. (2022) Longitudinally extensive transverse myelitis after covid vaccination: Response to letter. Hum Vaccin Immunother 18. https://doi.org/10.1080/21645515.2022.2096378
[48]	Hirose S, Hara M, Koda K, et al. (2021) Acute autoimmune transverse myelitis following COVID-19 vaccination: A case report. Medicine (Baltimore) 100: e28423. https://doi.org/10.1097/MD.0000000000028423
[49]	Pagenkopf C, Südmeyer M (2021) A case of longitudinally extensive transverse myelitis following vaccination against Covid-19. J Neuroimmunol 358: 577606. https://doi.org/10.1016/j.jneuroim.2021.577606

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