Clinical Profile and Outcomes of COVID-19-Associated Transverse Myelitis: A Case Report and Review of Literature.

Abstract

The purpose of this study was to evaluate demographics, clinical profiles, and outcomes of transverse myelitis (TM) in the setting of COVID-19 infection (iTM) or vaccination (vTM) and to describe a case of spontaneous resolution of iTM. Of a total of 158 articles that met our search criteria, 30 articles detailing 65 unique cases were included, of which 48 (73.8%) were iTM and 17 (26.2%) were vTM. The mean age of the iTM group was significantly lower as compared with vTM (43 ± 20.3 years vs 56.4 ± 18.6 years; p = 0.02). There were no gender differences between the groups. There were no significant differences in time to symptom onset (9.9 ± 14.3 days in iTM vs 7.6 ± 7.0 days in vTM, p = 0.2) between the groups. There were no significant differences between iTM and vTM in imaging features or laboratory abnormalities. The most common pharmacotherapy that was administered was intravenous (i.v.) corticosteroid (n = 56, 87.5%), followed by oral corticosteroids (n = 20, 31.2%), plasmapheresis (n = 19, 29.7%), and intravenous immunoglobulin (n = 14, 21.9%). Most of the cases reported a good outcome (n = 51, 79.7%) with no significant differences between the groups (77.1% in iTM vs 87.5% in vTM; p = 0.37). There are no significant differences with respect to time to presentation, clinical and radiological features, and in outcomes between iTM and vTM, suggesting a common pathogenesis. Approximately 80% of cases have a good outcome. Hence, early recognition and treatment are important. Our case demonstrates that treatment should be based on the clinical presentation rather than laboratory or imaging features.