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Abstract Details

Transverse Myelitis associated with COVID-19 in adults
Infectious Disease
P2 - Poster Session 2 (11:45 AM-12:45 PM)
4-003
To describe cases of transverse myelitis (TM) associated with mild COVID-19 in adults.
Post-infectious TM is described after various infections but is not as well-known after COVID-19.
We present a series of 2 cases who developed TM after infection with SARS-CoV-2.
Case 1: 55-year-old male with coronary artery disease presented with worsening paraparesis over 4 months, T4 sensory level and urinary retention, starting two weeks after mild COVID-19 illness. MRI showed T2 hyperintensity extending from the lower medulla to T3 spinal cord. CSF analysis revealed elevated protein and pleocytosis. His functional status improved after plasma exchange. Subsequently, his symptoms worsened and was treated with multiple courses of glucocorticoids. He recently started Rituximab and continues to have leg weakness with urinary retention.

Case 2: 66-year-old male with diabetes mellitus presented in a wheelchair with rapidly progressive paraparesis over 10 days, starting six weeks after mild COVID-19 illness. He was initially diagnosed with GBS and received IVIG with no improvement. MRI revealed T2 hyperintensity in the lateral corticospinal tracts of cervical and thoracic spinal cord. Somatosensory evoked potential testing showed mild bilateral demyelinating lesions involving the dorsal columns between the C6-parietal cortex. CSF analysis was normal. Plasma exchange therapy provided minimal improvement. He remains wheelchair bound with urinary urgency.

In both cases, other causes of TM including neuromyelitis optica, myelin oligodendrocyte associated disease, neurosarcoidosis and paraneoplastic myelopathy were ruled out.

SARS-CoV2 may cause a post-infectious TM. While causation remains difficult to prove, our cases suggest TM was precipitated by COVID-19 given the temporal association and no other identified etiology. Our cases continued to have significant neurologic deficits likely due to delayed diagnosis. These cases add to the growing body of evidence of neurologic complications associated with COVID-19. Further studies are needed to establish the incidence and outcomes of post-infectious TM after COVID-19.
Authors/Disclosures
Allyson Heng, MD (UAB Neurology)
PRESENTER 		Dr. Heng has nothing to disclose.
Nidhi Kikkeri, MD Dr. Kikkeri has nothing to disclose.
Vanessa Sui, MD (Blue Sky) Dr. Sui has nothing to disclose.
William R. Meador, MD Dr. Meador has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for ForensisGroup. The institution of Dr. Meador has received research support from PCORI. The institution of Dr. Meador has received research support from ROCHE/GENENTECH.
Shruti P. Agnihotri, MD An immediate family member of Dr. Agnihotri has stock in Pfizer. The institution of Dr. Agnihotri has received research support from Roche/ Genentech.