Acute transverse myelitis with Dysautonomia following SARS-CoV-2 infection: A case report and review of literature

Abstract

Objective: To report a unique case and literature review of post COVID-19 associated transverse myelitis and dysautonomia with abnormal MRI and CSF findings.

Background: Coronavirus disease have been reported to be associated with several neurological manifestations such as stroke, Guillain-Barré syndrome, meningoencephalitis amongst others. There are only few reported cases of transverse myelitis with the novel coronavirus (n-CoV-2) and only one reported case identifying dysautonomia in COVID-19 patient. Here, we identify a COVID-19 patient diagnosed with acute transverse myelitis in addition to dysautonomia following with complete resolution of symptoms.

Method: A retrospective chart review of a patient diagnosed with post SARS-CoV-2 infection acute transverse myelitis and dysautonomia, and a review of literature of all the reported cases of transverse myelitis and COVID-19, from December 1st, 2019 till December 25th, 2020, was performed.

Conclusion: To our knowledge, this is the first reported case of transverse myelitis and dysautonomia in a patient with SARS-CoV-2 infection, who responded to intravenous methyl prednisone and bromocriptine. Follow-up imaging of the spine showed complete resolution of the lesion. Further studies would be recommended to identify the underlying correlation between COVID-19 and transverse myelitis.

Keywords: Autoimmune disorder; COVID-19; Coronavirus disease 2019; Dysautonomia; MRI spine; SARS-CoV-2; Transverse myelitis.

Fig. 1

MRI sagittal STIR weighted image of Cervical spine – Fig. 1(a), sagittal Thoracic spine 1(b) & sagittal T1 post-contrest 1(c) reveals ill defined long segment signal alteration with mild cord expansion (blue arrow) 1(a) & (b) and no abnormal enhancement or the post-contrast study 1(c).

Fig. 2

Follow-up scan after 10 days from the first scan: MRI sagittal STIR weighted sagittal of Cervical spine Fig. 2(a), sagittal Thoracic spine 2(b) & sagittal T1 post-contrast 2(c) reveals no abnormal hyperintense cord signal changes and no abnormal enhancement on post contrast study 2(c).