Since the development and administration of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination, there has been an increasing number of vaccine associated adverse reactions reported. Although acute transverse myelitis has been well reported to be a direct effect of coronavirus 19 disease (COVID-19), there have been a limited but growing number of cases documenting this phenomenon as a likely immune mediated adverse reaction of the SARS-CoV-2 vaccine. Based on our literature review however, there has yet to be a case of this phenomenon described in the pediatric population.

Here, we report a case of a previously healthy 17-year-old male who had progressive lower extremity weakness and numbness which began two days after administration of the first dose of the Pfizer-BioNTech COVID-19 vaccine. On magnetic resonance imaging (MRI) of the spine, he was found to have edema and heterogenously hyperintense T2 signal involving the entirety of the spinal cord, most marked in the cervical and mid thoracic segments. The imaging was consistent with acute onset longitudinally extensive transverse myelitis (LETM). The patient underwent broad autoimmune, infectious, paraneoplastic, and inflammatory workup, all of which was non-diagnostic. Given no alternative cause was able to be identified, the LETM was attributed to be an adverse reaction of the COVID-19 vaccine. The patient’s symptoms improved considerably with high dose corticosteroid therapy, nevertheless he continued to have mild residual deficits upon discharge.