Acute transverse myelitis in COVID-19 infection

• Published in: BMJ case reports Vol. 13; no. 8; p. e236720
• Main Authors: Chow, Chian Chiang Nicholas, Magnussen, John, Ip, Jerome, Su, Yuen
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 11-08-2020; BMJ Publishing Group
• Series: Case report
• Subjects: Acute Disease; Aviation; Betacoronavirus; Blood; Case reports; Catheters; Constipation; Coronavirus Infections - complications; Coronaviruses; COVID-19; Cytokines; Dehydrogenases; Diagnosis, Differential; Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect; Glucocorticoids - therapeutic use; Glycoproteins; Humans; Infections; Inflammatory diseases; Magnetic Resonance Imaging - methods; Male; Methylprednisolone - therapeutic use; Middle Aged; Myelitis, Transverse - diagnostic imaging; Myelitis, Transverse - drug therapy; Myelitis, Transverse - etiology; Nervous system; Pandemics; Pneumonia, Viral - complications; Proteins; SARS-CoV-2; Serology; Severe acute respiratory syndrome coronavirus 2; Spinal cord; Spine - diagnostic imaging; Trauma; Viral infections; South America; emergency medicine; neurology; infectious diseases
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-236720

A 60-year-old man presented to hospital with bilateral lower limb weakness, urinary retention and constipation. He had been diagnosed with COVID-19 10 days prior. Clinical examination revealed global weakness, increased tone, hyperreflexia and patchy paresthesia in his lower limbs bilaterally. Preliminary blood tests performed revealed a mildly elevated C reactive protein and erythrocyte sedimentation rate but was otherwise unremarkable. MRI scan of his whole spine demonstrated hyperintense T2 signal centrally from T7 to T10, suggestive of acute transverse myelitis. A lumbar puncture showed elevated protein count but normal glucose and white blood cell count. Serological testing for other viruses was negative. His neurological symptoms improved significantly after treatment with intravenous methylprednisone. This case highlights a potential neurological complication of COVID-19 infection.