Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak became one of the most global health challenges in the recent century. Transverse myelitis is a rare medical condition reported in few case reports following COVID-19 infection. We present a 63 years old female with post-COVID-19 transverse myelitis. The patient had paraplegia combined with autonomic symptoms and T4 sensory level. Initial treatment started with methylprednisolone. Since the patient did not respond to the prednisolone, plasmapheresis was considered for the patient. Unfortunately, the patient could not tolerate the plasmapheresis. We considered rituximab for the next plan, but unfortunately, the patient died due to respiratory failure. To date, there is no published study to evaluate different mechanisms of post/para COVID-19 transverse myelitis. However, the post/para COVID-19 transverse myelitis mechanism seems to be heterogeneous; the activation of a silent autoimmune disease can probably justify some unusual clinical presentations of a viral illness. Further studies are needed to categorize the underlying mechanisms of post/para COVID-19 transverse myelitis and effective treatments regarding the primary pathology.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is one of the strains of human coronaviruses (HCoV) transmitted as RNA virus
The mechanisms mentioned above are suggested for post/para COVID-19 infectious Transverse myelitis (TM); we believe the fundamental mechanism is heterogenous in each individual
We proposed a new probable mechanism that signifies an underlying silent immune disease in some patients may have a role in victims’ response to SARS-COV-2 infection based on published case reports and certainly discuss recent experiences and management towards handling COVID-19 induced transverse myelitis
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is one of the strains of human coronaviruses (HCoV) transmitted as RNA virus. We proposed a new probable mechanism that signifies an underlying silent immune disease in some patients may have a role in victims’ response to SARS-COV-2 infection based on published case reports and certainly discuss recent experiences and management towards handling COVID-19 induced transverse myelitis. The patient developed progressive paraparesis, urinary incontinency, and back pain progressed rapidly, which led to the current admission. Due to abnormal lab data and multiple organ involvement, the therapeutic team considered Rituximab to modify post-COVID-19 immunological processes. At this time, the patient developed shortness of breathing. The patient passed away in the setting of respiratory failure and multiple organ failure
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