To increase awareness of myelitis as an unusual complication of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection.

We present a 60-year-old male with a past medical history of hypertension, anxiety, and recent SARS-CoV-2 infection who presented to our institution for evaluation of ascending numbness and gait instability. The initial neurological examination revealed decreased pinprick sensation up to the level of the nipples, absent vibration in toes, ankles, knees, and severe ataxia in bilateral lower extremities. The Romberg test was positive, and the patient had prominent gait instability. An MRI of the brain showed incidental finding of superior cerebellar vermis atrophy. An MRI of the spine showed numerous patchy non-enhancing T2 hyperintense lesions in the cervical and thoracic spine. A lumbar puncture was unremarkable. Autoimmune encephalopathy panel results from serum and CSF were negative. The infectious workup for syphilis, West Nile virus, Epstein-Barr virus, cytomegalovirus in serum and CSF was normal. Heavy metals, copper, zinc, and vitamin B6 were unremarkable. The patient was diagnosed with post-infectious myelitis in the setting of recent SARS-CoV-2 infection. He received 1g of IV methylprednisolone for 5 days. Due to improvement, he was discharged to a rehabilitation facility; however, the patient clinically deteriorated and was readmitted for severe bilateral lower extremity weakness. During the second hospitalization, he underwent 5 sessions of plasmapheresis and IV methylprednisolone. After prolonged rehabilitation and a slow steroid taper, the patient returned to his baseline without residual deficits.