401 - Acute Transverse Myelitis Secondary to COVID-19 Infection: A Case Report

Case Diagnosis: 34-year-old female with acute transverse myelitis secondary to COVID-19.

Case Description: A 34-year-old female with a history of fibromyalgia and ureteral stenosis presented with acute respiratory failure with an 88% oxygen saturation, tachycardia, cough, chest pain, headache, and diarrhea five days after testing positive for COVID-19. She was admitted and treated with supplemental oxygen, Remdesivir, convalescent plasma, and IV Decadron. Her symptoms improved; however, three days later, she noticed BLE weakness, paresthesia, ataxia, diplopia, headache, and difficulty voiding her bowel and bladder. On examination, she had horizontal diplopia, bitemporal hemianopsia, postural tremors, diffuse patchy 2-4/5 weakness, 3+ hyperreflexia, and paresthesia with a c6 sensory level. A diagnosis of acute transverse myelitis (ATM) was made and she was treated with high-dose steroids and plasmapheresis x 4 with planned outpatient neurosurgical follow-up and PT. Five months later, the patient presented to an outpatient physiatry clinic with ascending allodynia, 2-3/5 BLE weakness, and sensory deficits to pain, light touch, and proprioception in her toes.

Discussions: ATM occurs when the immune system attacks healthy myelin in the spinal cord, causing potential weakness/paralysis, incontinence, and significant pain. Studies have shown that nearly 50 ATM cases have been identified out of 85 million COVID-19 cases globally, making COVID-19 one of the most common causes of ATM. This case report helps demonstrate that the novel Coronavirus targets both the brain and the spinal cord, and the early-onset of TM suggests the damage was inflicted by the virus itself.

Conclusions: From a psychosocial perspective, the patient identified as a driven and determined individual known to be the main source of support for several family members and perceived her functional decline as a threat to her identity. Cases like this speak volumes to the need for research to identify the responsible antigens and immunopathogenesis of COVID-19-associated ATM.