Covid-19 post-infectious acute transverse myelitis responsive to corticosteroid therapy: report of two clinical cases

Abstract

SARS-COV-2 infection has affected millions of individuals with a wide range of clinical manifestations, including central and peripheral nervous systems through several mechanisms. A rare but potentially severe manifestation of this virus is transverse myelitis. Herein, we report on two patients who developed paraparesis, sensory deficit, and autonomic changes on the tenth day after infection by COVID-19. A 27-year-old man, previously healthy, had symptoms of COVID-19 confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience acute paraparesis, urinary retention, constipation, and hypoesthesia up to the T4 level. The second patient is a 50-year-old man, previously healthy, who had symptoms of the flu-like syndrome. The diagnosis of COVID-19 infection was confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience paraparesis, urinary incontinence, and hypoesthesia up to the T6 level. The neuroimaging and cerebrospinal fluid (CSF) analysis of both patients confirmed acute transverse myelitis after COVID-19 infection. High-dose corticosteroid therapy was started, and both patients showed rapid recovery from their deficits. Although rare, post-infectious transverse myelitis may be related to SARS-COV-2 infection and should be quickly recognized. Although controlled studies are needed, treatment with corticosteroid therapy in high doses was effective in these patients.

Keywords: Acute transverse myelitis; COVID-19; Coronavirus; Severe acute respiratory syndrome by coronavirus 2 (SARS-COV-2).

Fig. 1

MRI of the cervical and thoracic spine of patient 1 demonstrating multiple foci of hyperintense signal on T2-weighted sequences, non-contiguous at C6-C7, C7-T1, T2-T4, T6, and T12-L1 with damage to the lateral funiculus, anterior spinal horn, and posterior cord (arrows). a Sagittal T2-weighted image of cervical and thoracic spine. b Sagittal T2-weighted image of cervical and thoracic spine. c Sagittal T1-weighted image of thoracic spine after the administration of gadolinium contrast. d Sagittal T1-weighted image of cervical spine after the administration of gadolinium contrast

Fig. 2

MRI of the cervical and thoracic spine of patient 2 demonstrating a hyperintense signal on T2-weighted sequences at T5–T6, affecting the anterolateral spine, predominantly on the left, and enhancing lesions at C2, C7-T1, and T11 (arrows). a Sagittal T2-weighted image of thoracic spine. b Sagittal T1-weighted image of cervical spine after the administration of gadolinium contrast. c Axial T1-weighted image at C2 after the administration of gadolinium contrast. d Sagittal T1-weighted image of thoracic spine after the administration of gadolinium contrast. e Axial T1-weighted image at T11 after the administration of gadolinium contrast