Post-Infectious Acute Transverse Myelitis in a COVID-19 Patient

TL;DR

A young man developed spinal inflammation after a mild case of COVID-19, showing that the virus might trigger neurological complications.

Contribution

This case report adds to the evidence that COVID-19 can lead to post-infectious transverse myelitis.

Findings

Neurological symptoms appeared eight days after initial COVID-19 symptoms.

MRI showed a T2 hyperintense signal from C3 to the conus, consistent with myelitis.

High-dose steroids led to significant recovery of motor and bladder/bowel function.

Abstract

A 41-year-old man with no comorbidities presented with features consistent with a subacute partial upper thoracic myelopathy, two days after treatment in the emergency department for acute urinary retention. On examination, he was ambulatory but had an unsteady gait and lower limb weakness, with brisk reflexes, upgoing plantars, and subtle sensory changes at the T4-T5 level. The patient developed neurological symptoms eight days after the initial onset of COVID-19. An urgent magnetic resonance imaging (MRI) of the spine demonstrated a T2 hyperintense signal extending from C3 to the conus, while cerebrospinal fluid analysis revealed lymphocytosis. Following treatment with high-dose intravenous methylprednisolone, the patient showed significant clinical improvement, with recovery of strength and bladder and bowel function. This case highlights COVID-19 as a possible post-infectious trigger for transverse myelitis and underscores the need to investigate acute urinary retention in young patients.

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