A case of longitudinally extensive transverse myelitis following vaccination against Covid-19

Abstract

Background: Longitudinally extensive transverse myelitis (LETM) is a rare subtype of transverse myelitis (TM) that potentially results in relevant disability. Apart from association to neuromyelitis optica and other chronic demyelinating diseases of the central nervous system, many other aetiologies are known. Particularly systemic infections and vaccination are considered potential triggers for immune mediated inflammation of the spinal cord. In the course of the current Covid-19 pandemic several cases of TM following Covid-19 infection have been described. Here we present a case of LETM following vaccination against Covid-19 with AZD1222, AstraZeneca. An extensive diagnostic work up was performed to rule out alternative causes, including prior and current Covid-19 infection.

Conclusion: To our knowledge this is first case of LETM possibly related to Covid-19 vaccination that is published after marketing authorisation of various vaccine candidates.

Keywords: Covid-19; Covid-19 vaccination; Longitudinally extensive transverse myelitis; SARS-CoV-2; Transverse myelitis; Vaccine related disorder.

Fig. 1

Spinal cord MRI: (A) sagittal T2 weighted image of cervicothoracic spine shows hyperintense signal with wide axial and longitudinal extent. (B) Follow-up MRI after 8 days shows decline of T2 hyperintensity in axial and longitudinal extent.