# Plasmapheresis in post-COVID-19 myelitis: A case report

## TL;DR

A 61-year-old vaccinated man developed myelitis after a mild case of COVID-19 and showed significant improvement after plasmapheresis treatment.

## Contribution

This case report presents plasmapheresis as a promising treatment for post-COVID-19 myelitis.

## Key findings

- The patient showed no improvement with methylprednisolone but improved after plasmapheresis.
- Three months post-treatment, the patient regained significant muscle strength and resolved sensory and urinary symptoms.

## Abstract

Background: Previous studies have delineated different neurological manifestations associated with coronavirus disease 2019 (COVID-19). Myelitis is identified as a rare neurological complication resulting from a COVID-19 infection. Limited information is available regarding the treatment of patients experiencing this condition.

Case report: This report extracts data from the medical record of a post-COVID-19 myelitis patient at Buriram Hospital and follows up prospectively on the patient’s symptoms after treatment.

A 61-year-old man, previously vaccinated for COVID-19 and with a history of hypertension and dyslipidemia, experienced progressive bilateral lower-extremity weakness (recorded as muscle strength grade 2/5 in both lower extremities) for 6 weeks. He had a mild case of COVID-19 2 months earlier, which resolved in 10 days without specific treatment. However, 2 weeks after being diagnosed with COVID-19, he developed weakness in his lower limbs, numbness below the nipple, and urinary retention. Spinal magnetic resonance imaging revealed multifocal longitudinal myelitis. Despite initial treatment with methylprednisolone, the patient showed no clinical improvement. Consequently, he underwent five cycles of plasmapheresis. Three months after discharge, a notable improvement was observed, with his muscle strength graded at 4/5 in both lower extremities and the resolution of sensory and urinary symptoms.

Conclusions: We presented the case of a COVID-19-vaccinated patient, in whom COVID-19 infection might have led to myelitis. We found promising results in treating prolonged COVID-19-related myelitis symptoms through the use of plasmapheresis.