A 31-year-old male patient presented with acute tetraparesis and urinary retention 1 day after the first dose of the coronavirus disease 2019 (COVID-19) vaccine. COVID-19 PCR (polymerase chain reaction (PCR) was negative, and IgM (Immunoglobulin M) COVID-19 was reactive. Electromyography revealed an asymmetric motor-sensory axonal polyneuropathy. Cervical magnetic resonance imaging (MRI) revealed longitudinally extensive transverse cervical myelitis (Figure 1). Immunoglobulin treatment for five days improved arm strength. Methylprednisolone was started for five days without improvement. In addition, the patient underwent plasmapheresis with improvement. Blood and cerebrospinal fluid tests were performed, excluding autoimmune diseases, other infections, and neuromyelitis optica (Figure 2). He returned to walking unassisted after 60 days with mild hypoesthesia in his left foot and mild urinary retention. Previous studies reported similar and worse outcomes after the COVID-19 vaccine and other viral infections11. Vasconcelos TMF, Oliveira DN, Ferreira GM, Torres FC, Castro JDV, Braga-Neto P, et al. Covid-19 post-infectious acute transverse myelitis responsive to corticosteroid therapy: report of two clinical cases. J Neurovirol. 2021;27(5):791-6. Available from: https://doi.org/10.1007/s13365-021-01010-x. Epub ahead of print. PMID: 34449062; PMCID: PMC8393787.
https://doi.org/10.1007/s13365-021-01010...
,22. Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute Transverse Myelitis (ATM): Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021;12:653786. Available from: https://doi.org/10.3389/fimmu.2021.653786. PMID: 33981305; PMCID: PMC8107358.
https://doi.org/10.3389/fimmu.2021.65378...
. Our report presents one of the earliest cases described after vaccination; however, it has already been registered at a similar time33. Khan E, Shrestha AK, Colantonio MA, Liberio RN, Sriwastava S. Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature [published online ahead of print, 2021 Sep 5]. J Neurol. 2021;269:1121-32. Available from: https://doi.org/10.1007/s00415-021-10785-2
https://doi.org/10.1007/s00415-021-10785...
. Such cases usually occur with extended latency periods, probably by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens in the COVID-19 vaccine or its chimpanzee adenovirus adjuvant. These antigens can cause myelitis via immune mechanisms22. Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute Transverse Myelitis (ATM): Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021;12:653786. Available from: https://doi.org/10.3389/fimmu.2021.653786. PMID: 33981305; PMCID: PMC8107358.
https://doi.org/10.3389/fimmu.2021.65378...
.
MRI cervical spine in sagittal T1 (a), sagittal T2 (b), sagittal short tau inversion recovery (STIR) (c), and axial T2 (d). Images demonstrate a longitudinally extensive hyperintense signal (b, c, and d - arrows). Suggestive of longitudinally extensive transverse myelitis.
ACKNOWLEDGMENTS
The authors are grateful to the Brazilian National Council for Scientific and Technological Development (CNPq) for the funding of the Fellowship to author Pedro Braga Neto and to Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) for the funding to author Pedro Braga Neto (88881.505364/2020-01).
REFERENCES
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1Vasconcelos TMF, Oliveira DN, Ferreira GM, Torres FC, Castro JDV, Braga-Neto P, et al. Covid-19 post-infectious acute transverse myelitis responsive to corticosteroid therapy: report of two clinical cases. J Neurovirol. 2021;27(5):791-6. Available from: https://doi.org/10.1007/s13365-021-01010-x. Epub ahead of print. PMID: 34449062; PMCID: PMC8393787.
» https://doi.org/10.1007/s13365-021-01010-x -
2Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute Transverse Myelitis (ATM): Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021;12:653786. Available from: https://doi.org/10.3389/fimmu.2021.653786. PMID: 33981305; PMCID: PMC8107358.
» https://doi.org/10.3389/fimmu.2021.653786 -
3Khan E, Shrestha AK, Colantonio MA, Liberio RN, Sriwastava S. Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature [published online ahead of print, 2021 Sep 5]. J Neurol. 2021;269:1121-32. Available from: https://doi.org/10.1007/s00415-021-10785-2
» https://doi.org/10.1007/s00415-021-10785-2
Publication Dates
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Publication in this collection
06 June 2022 -
Date of issue
2022
History
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Received
21 Jan 2022 -
Accepted
25 Mar 2022