Acute Transverse Myelitis Following COVID-19 Vaccination

Abstract

An increasing number of people are undergoing vaccination for COVID-19 because of the ongoing pandemic. The newly developed, genetically engineered mRNA vaccines are critical for controlling the epidemic disease. However, major adverse effects, including neuroimmunological disorders, are being attributed to this vaccine. For instance, several cases of acute transverse myelitis (ATM) after COVID-19 vaccination have been reported in clinical trials. Here, we report an exceedingly rare case of longitudinally extensive transverse myelitis (LETM), a rare subtype of ATM involving three or more vertebral segments, that occurred shortly after vaccination with the Moderna COVID-19 (mRNA-1273) vaccine, with a comorbidity of vitamin B12 deficiency. The findings of subsequent investigations suggest the possibility that autoimmune responses are triggered by the reactions between anti-SARS-CoV-2 spike protein antibodies and tissue proteins, as well as the interaction between spike proteins and angiotensin-converting enzyme 2 receptors.

Keywords: COVID-19; COVID-19 vaccination; LETM; mRNA vaccine; myelitis; vitamin B12.

Figure 1

Clinical course before admission. (MRI: magnetic resonance imaging; CSF: cerebrospinal fluid).

Figure 2

Cervical MRI images of a 76-year-old female with longitudinally extensive transverse myelitis: (A) sagittal T2-weighted image showing hyperintensity in the cervical cord at the C2–C5 levels; (B) sagittal T1-weighted image with contrast showing ring enhancement in the cervical cord at the C3 level; (C) axial T2-weighted image showing extensive hyperintensity in the cervical cord at the C3 level; (D) axial T1-weighted image with contrast showing right-sided enhancement in the cervical cord at the C3 level (arrowhead).

Figure 3

Cervical MRI images two weeks after discharge: (A) sagittal T2-weighted image showing the decreased size of hyperintensity in the cervical cord at the C3 level; (B) sagittal T1-weighted image with contrast showing minimal enhancement in the cervical cord at the C3 level.