Transverse myelitis after Johnson & Johnson COVID-19 vaccine: illustrative case

Abstract

Background: Transverse myelitis is a rare neurological occurrence with varied presentation. Imaging is necessary to properly diagnose this condition; however, identifying the cause of this condition may often be difficult.

Observations: An otherwise healthy patient presented to the clinic with peculiar neurological symptoms without an obvious underlying cause. Imaging evidenced no significant structural defects but did lead to discovery of cord enhancement compatible with a diagnosis of transverse myelitis. Corticosteroid treatment was initiated rapidly to address this pathology, and the patient recovered without deficits. To identify the underlying cause, patient medical history was reviewed thoroughly and compared with existing literature. Previous tuberculosis infection could be a less likely cause of the neurological symptoms. However, recent vaccination with the Johnson & Johnson coronavirus disease 2019 (COVID-19) vaccine could be a more likely cause of the transverse myelitis, which has been rarely reported.

Lessons: Transverse myelitis after COVID-19 infection has been an escalating phenomenon. However, transverse myelitis after COVID-19 vaccination is a rare occurrence that is also on the rise. Given the increased rates of vaccination, transverse myelitis should not be overlooked as a potential pathology, due to the severity of neurological impairment if this condition is not treated rapidly.

Keywords: Johnson & Johnson COVID-19 vaccine; rapid corticosteroid initiation; transverse myelitis.

FIG. 1.

Sagittal T2-weighted MRI showing severe cord edema from C1 to T1–2. Signal enhancement is visible in the cervical spinal cord, and the thecal sac at C4–5 measures 7 mm. Note: A thecal sac less than 14 mm is concerning for spinal cord compression.