A Rare Case of Longitudinally Extensive Transverse Myelitis Following Pfizer-BioNTech COVID-19 Vaccination with a Favourable Outcome

  • Ojbindra KC Department of Hospital Medicine, Faith Regional Health Services, Norfolk, Nebraska, USA
  • Punya Hari Dahal Department of Hospital Medicine, Faith Regional Health Services, Norfolk, Nebraska, USA
  • Manisha Koirala Department of Hospital Medicine, Faith Regional Health Services, Norfolk, Nebraska, USA
  • Sumeet Kumar Yadav Department of Hospital Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA

Keywords

COVID-19, transverse myelitis, mRNA COVID-19 vaccines, autoimmune disease

Abstract

Introduction: mRNA COVID-19 vaccines are very safe, but rare adverse events such as transverse myelitis have been reported after COVID-19 vaccination.

Case Description: We report the case of 50-year-old man who presented with progressive lower extremity weakness, back pain and urinary retention after his second dose of the Pfizer COVID-19 vaccine. MRI of the spine revealed longitudinally extensive transverse myelitis (LETM). He recovered completely after treatment with intravenous methylprednisone and physical therapy. 

Discussion: This case highlights the rare association between LETM and COVID-19 vaccines and encourages clinicians to maintain a high index of suspicion for prompt diagnosis and treatment.

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References

  • Kitley JL, Leite MI, George JS, Palace JA. The differential diagnosis of longitudinally extensive transverse myelitis. Mult Scler J 2012;18(3):271–285.
  • Trebst C, Raab P, Voss EV, Rommer P, Abu-Mugheisib M, Zettl UK, et al. Longitudinal extensive transverse myelitis—it's not all neuromyelitis optica. Nat Rev Neurol 2011;7:688–698.
  • Baxter R, Lewis E, Goddard K, Fireman B, Bakshi N, DeStefano F, et al. Acute demyelinating events following vaccines: a case-centered analysis. Clin Infect Dis 2016;63:1456–1462.
  • Goss AL, Samudralwar RD, Das RR, Nath A. ANA investigates: neurological complications of COVID-19 vaccines. Ann Neurol 2021;89(5):856–857.
  • Bhat A, Naguwa S, Cheema G, Gershwin ME. The epidemiology of transverse myelitis. Autoimmun Rev 2010;9(5):A395–A399.
  • Agmon-Levin N, Kivity S, Szyper-Kravitz M, Shoenfeld Y. Transverse myelitis and vaccines: a multi-analysis. Lupus 2009;18(13):1198–1204.
  • Hsiao YT, Tsai MJ, Chen YH, Hsu CF. Acute transverse myelitis after COVID-19 vaccination. Medicina 2021;57(10):1010.
  • Zanoni G, Nguyen TM, Destefani E, Masala L, Nardelli E, Tridente G. Transverse myelitis after vaccination. Eur J Neurol 2002;9:696–697.
  • Vojdani A, Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin Immunol 2020;217:108480.
  • Gao JJ, Tseng HP, Lin CL, Shiu JS, Lee MH, Liu CH. Acute transverse myelitis following COVID-19 vaccination. Vaccines (Basel) 2021;9(9):1008.
  • Alabkal J, Rebchuk AD, Lyndon D, Randhawa N. Incomplete subacute transverse myelitis following vaccination with Pfizer-BioNTech COVID-19 mRNA vaccine: a case report. Cureus 2021;13(12):e20460.
  • Hirose S, Hara M, Koda K, Natori N, Yokota Y, Ninomiya S,et al. Acute autoimmune transverse myelitis following COVID-19 vaccination: a case report. Medicine (Baltimore) 2021;100(51):e28423.
  • Fernandes J, Jaggernauth S, Ramnarine V, Mohammed SR, Khan C, Panday A. Neurological conditions following COVID-19 vaccinations: chance or association? Cureus 2022;14(2): e21919.
  • Miyaue N, Yoshida A, Yamanishi Y, Tada S, Ando R, Hosokawa Y, Yabe H, Nagai M. A case of refractory longitudinally extensive transverse myelitis after severe acute respiratory syndrome oronavirus 2 vaccination in a japanese man. Intern Med 2022;61(5):739-742.
  • Khan E, Shrestha AK, Colantonio MA et al. Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature. J Neurol 2022;269:1121–1132.
  • Fitzsimmons W, Nance CS. Sudden onset of myelitis after COVID-19 vaccination: an under-recognized severe rare adverse event. Available at SSRN 3841558. 2021 May 5. doi.org/10.2139/ssrn.3841558
  • McLean P, Trefts L. Transverse myelitis 48 hours after the administration of an mRNA COVID 19 vaccine. Neuroimmunology Reports 2021;1:100019.
  • Nakano H, Yamaguchi K, Kawabata K, Asakawa M, Matsumoto Y. Acute transverse myelitis after BNT162b2 vaccination against COVID-19: Report of a fatal case and review of the literature. J Neurol Sci 2022;434:120102.
  • Eom H, Kim SW, Kim M, Kim YE, Kim JH, Shin HY, Lee HL. Case reports of acute transverse myelitis associated with mRNA vaccine for COVID-19. J Korean Med Sci 2022;37(7):e52.
  • Albokhari AA, Alsawas A, Adnan MH, Alasmari A, Aljuhani S, Almejalli M, Kedah H. Acute inflammatory transverse myelitis post-Pfizer-BioNTech-COVID-19 vaccine in 16-year-old. JMRI 2021;5:1-4. doi: 10.25259/JMRI_25_2021
  • Published: 2022-09-15

    Issue: 2022: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    1.
    KC O, Dahal PH, Koirala M, Yadav SK. A Rare Case of Longitudinally Extensive Transverse Myelitis Following Pfizer-BioNTech COVID-19 Vaccination with a Favourable Outcome. EJCRIM 2022;doi:10.12890/2022_003553.