ECTRIMS 2021 – ePoster

Abstract

Introduction: COVID-19 induced longitudinal extensive myelitis (LEM) is an extremely rare clinical manifestation. Aims and Methods: In this case study, we report a woman of LEM which appeared fifteen days after COVID-19 infection. Results: A 39-year-old woman, suffering from gradually increased weakness and severe pain at lower limbs and urinary retention was admitted to the emergency department. She was diagnosed with COVID-19 infection 15 days ago and fully recovered from respiratory symptoms. Her initial neurological examination showed loss of muscular strength in right lower limb 1/5 and left lower limb 2/5, hyperreflexia in the lower limbs and generalized allodynia. All modalities of sensation were diminished at the T10 segmental level. Her nasopharyngeal and oropharyngeal swab for polymerase chain reaction (PCR) to detect SARS-CoV-2 was positive. Cerebrospinal fluid (CSF) showed pleocytosis (whitecell count 110/mm3 ) with mostly polymorphonuclear leukocytes (90%), elevated protein (67 mg/dl) and normal glucose (78 mg/dl;concurrent serum glucose level was 96 mg/dl). Serology for SARS-CoV2 in CSF demonstrated infection (anti-SARS-CoV-2 IgG: 5.47 (negative<1). The other serum and CSF tests were negative for differential diagnosis of acute transverse myelitis. Electromyography (EMG) showed normal motor and sensory nerve conduction velocity in the upper and lower limbs. The somatosensory evoked potention test (SEP) determined prolonged latency of bilateral tibial nerve cortical responses with low-amplitudes. Cervical and thoracic MRI demonstrated a long segment of T2 hyperintensities within the central cord extending from C2-C3 level to T10 level. The patient was treated with methylprednisolone 1 g/d IV for five days. Because of her progressed neurological condition, the patient received five sessions of plasma exchange and additionally methylprednisolone 1 g IV was given for another ten days. The patient was discharged to an inpatient rehabilitation facility without any clinical improvement. Conclusions: Acute transverse myelitis have been reported during respiratory diseases due to SARS-CoV-2. Otherwise, the clinical manifestation of LEM induced by COVID-19 seen during infection is very rare. To the best of our knowledge, our case is the second one of LEM induced by COVID-19 confirmed by CSF antibody. This case remarks the importance of recognition and early treatment of LEM during COVID-19 infection.