Abstract Details

Title A rare case of an acute ascending longitudinally extensive necrotizing transverse myelitis in a young woman: a severe post-COVID-19 infection neurological complication

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-003

Objective N/A

Background Neurological injuries from severe acute respiratory syndrome coronavirus 2 (COVID-19) are becoming recognized in the central and peripheral nervous systems. Pathophysiology processes include a hyperinflammatory immune response due to the affinity of COVID-19 to human ACE2 receptors and multi-organ failure.

Design/Methods

CASE REPORT

This report highlights a unique presentation of a rapidly progressive, hyperacute to chronic, necrotizing transverse myelitis with associated COVID-19 long haul syndrome in a 31-year-old Venezuelan obese woman without other vascular risk factors. There was a preceding symptomatic COVID-19 infection. Symptoms included headaches, dysgeusia, asymmetric ascending proximal more than distal paresis, lumbago with dysesthesias, autonomic dysautonomia, hyperreflexia with clonus, and severe functional mobility impairment.

Results Neuraxis imaging showed a longitudinally extensive transverse myelitis (LETM) with T7-T9 enhancement and expansion throughout the thoracic spine (T4-T11). CSF studies showed lymphocytic pleocytosis with elevated protein. Aggressive empiric treatment included 1G of IV methylprednisolone, plasmapheresis (PLEX), and high-dose cyclophosphamide given the life-threatening progression of clinical symptoms. Repeat imaging post-treatment showed expansion of lesions to the cervical cord with sparing of the brainstem, stabilizing after cyclophosphamide initiation. Clinically, there was partial recovery of upper extremity sensation and strength. A T5-T6 tissue biopsy showed evidence of necrotizing myelitis with extensive neutrophil and lymphocyte infiltration. Given clinical progression, a repeat round of immunosuppression, including a monoclonal complement antibody, was pursued. Post-rehabilitation, the patient's symptoms improved above the thoracic spine but not below it.

Conclusions

To our knowledge, this is the most severe form of COVID-19 associated necrotizing myelitis ever reported. Future research may clarify the molecular pathways that trigger neurological injury in patients with severe COVID-19 infection-associated spinal cord complications and increase therapeutic options.

Authors/Disclosures
Franklyn Rocha Cabrero, MD PRESENTER	Dr. Rocha Cabrero has nothing to disclose.
	No disclosure on file
Luis Guada-Delgado, MD (University of Miami)	Dr. Guada-Delgado has nothing to disclose.
Ashok Verma, MD, FAAN (University of Miami, Clinical Research Bldg)	Dr. Verma has nothing to disclose.

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