Transverse Myelitis in a Healthy Adult Female Patient: A Rare Viral Etiology

Abstract

Transverse myelitis (TM) is an uncommon but extensively documented neurological disorder marked by acute spinal cord inflammation, resulting in a spectrum of impairments including motor, sensory, and autonomic disturbances. We outline a rare case of viral-induced TM linked to COVID-19 and Coxsackie B viral infections. A 25-year-old healthy female patient presented with acute bilateral upper and lower extremity weakness, paresthesia, and urinary retention. MRI of the cervical spine revealed abnormal marrow signal intensity. Laboratory investigation highlighted the presence of SARS-CoV-2 RNA; Coxsackie B virus subtypes 1, 2, 4, 5, and 6; and positive Lyme disease IgG subtype. Lumbar puncture and systemic autoimmune cases of myelopathy were unrevealing. Treatment included high-dose steroids, plasmapheresis, Foley catheter placement, and continual physical therapy. Despite improvements, the patient did not reach baseline and was discharged for outpatient physical/occupational rehabilitation. To our knowledge, this is the only case that describes viral-induced TM associated with COVID-19, Coxsackie B, and Lyme disease simultaneously. The rarity of this case highlights the necessity for further investigation into the pathogenesis of viral-induced TM and whether viral causes contribute synergistically or independently to the onset of TM.

Keywords: acute cervical transverse myelitis; covid-19; coxsackie b virus; neuroimmunology; spinal cord inflammation.

Figure 1. Axial T2-weighted image demonstrating a central pattern of abnormal T2 hyperintense signal (blue arrow) within the spinal cord, occupying greater than two-thirds of the cross-sectional area of the cord. This is a common feature of transverse myelitis.

Figure 2. Sagittal T2-weighted image demonstrating a longitudinal band of abnormal hyperintense signal within the spinal cord, spanning from C4-C5 through C7-T1 (red arrow), with minimal associated cord edema/swelling. Involvement of the spinal cord spanning three or more vertebral body segments, as in this case, is typical in transverse myelitis.

Figure 3. Sagittal T1 postcontrast image demonstrating no abnormal enhancement within the spinal cord. Contrast enhancement is variable in cases of transverse myelitis.