Post-COVID-19 longitudinally extensive transverse myelitis: is it a new entity?

Abstract

Introduction: To the best of our knowledge, here we present two post-COVID19 longitudinally extensive transverse myelitis (LETM) with atypical presentations CASE PRESENTATIONS: A 44-year-old male who did not have any previous medical condition and a 73-year-old male foreigner who did not have any disease other than type 2 diabetes mellitus were admitted to our neurology clinic in the same period with similar clinical presentations of transverse myelitis. Upon admission, paraplegia and urinary-fecal incontinence were observed in their neurological examination. Neurological complaints had started within approximately 3-4 weeks following the resolution of the COVID-19 infection. Thoracic lower segment LETM was observed on spinal magnetic resonance imaging (MRI) in one of the patients, and long segment myelitis extending from the lower thoracic segment to the conus medullaris was observed in the other one. No significant diagnostic positivity was present in their diagnostic evaluation. In both cases, we assume a post-infectious etiology in terms of secondary immunogenic overreaction following COVID-19.

Conclusion: Our patients improved with multiple treatments such as methylprednisolone, intravenous immunoglobulin, and plasmapheresis. Whether post-infectious myelitis behaves differently from other viral infections after COVID-19 is currently unclear. Long lag times appear to be a post-infectious neurological complication resulting from the host response to the virus.

Keywords: Autoimmunity; COVID-19; Post-infectious; Transverse myelitis.

Fig. 1

Spinal and brain MR imaging of the patients. Patient 1 (upper row): sagittal spinal T2W (a), STIR (b), and axial T2W (d, e) images show a T2-hyperintense lesion centrally located and longitudinally extending from T5 to T12. Postcontrast sagittal spinal T1W image (c) does not reveal any contrast enhancement. Axial brain FLAIR (f, g) images reveal normal characteristics. Patient 2 (lower row): sagittal (a) and axial (d) T2W and sagittal pre-contrast T1W MR images demonstrate a T2-hyperintense lesion longitudinally extending along the lower thoracic cord segment involving conus medullaris. Postcontrast sagittal (c) and axial (e) T1W images demonstrate heterogeneous contrast enhancement of the cord lesion. Axial brain FLAIR (f, g) images reveal normal characteristics