# 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.

## Key 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.