Parainfectious Transverse Myelitis in a Pregnant Woman: A Rare Clinical Entity

TL;DR

A pregnant woman developed rare parainfectious transverse myelitis, which improved with immunomodulatory treatment and resulted in near-complete recovery.

Contribution

This case highlights the management and successful treatment of parainfectious transverse myelitis during pregnancy.

Findings

The patient showed neurological improvement after treatment with corticosteroids and intravenous immunoglobulin.

She delivered a preterm infant but achieved near-complete motor recovery postpartum.

Intravenous immunoglobulin may be a safe and effective adjunct in treating PITM during pregnancy.

Abstract

Transverse myelitis (TM) is an inflammatory disorder of the spinal cord characterized by motor, sensory, and autonomic impairments. Parainfectious transverse myelitis (PITM) represents a post-infectious, immune-mediated entity. Its occurrence during pregnancy is rare and presents with unique diagnostic and therapeutic challenges.

We report a 31-year-old primigravida at 32 weeks of gestation who presented with acute-onset bilateral lower limb weakness, sensory loss, and bladder involvement following a febrile illness. MRI spine revealed longitudinally extensive transverse myelitis (C3-T2). The cerebrospinal fluid analysis showed lymphocytic pleocytosis with a negative infectious and autoimmune work-up. She was treated with intravenous methylprednisolone, which was followed by intravenous immunoglobulin (2 g/kg over five days), with a gradual neurological recovery. She subsequently developed urinary sepsis at 35 weeks and underwent emergency cesarean section, delivering a preterm infant. At two months postpartum, she had near-complete motor recovery with only mild bladder urgency.

While PITM in pregnancy is rare, it is potentially reversible with timely immunomodulatory therapy. Intravenous immunoglobulin may be considered as a safe and effective adjunct to corticosteroids in selected cases.

Figures