Disclosures: Rebecca Itskevich, DO: No financial relationships or conflicts of interest

Case Diagnosis: 26-year-old male with history of lumbar fracture 3 years ago, COVID-19 infection 6 months ago presenting with transverse myelitis of unclear etiology.

Case Description: Patient initially presented to ED with severe constipation and workup unrevealing, given polyethylene glycol and discharged home. He returned to ED three days later with progressing lower extremity paresthesias and weakness, reduced genital sensation, and urinary incontinence. Imaging demonstrated non-enhancing lesion with T2 signal extending from T8-T11. Etiology thought vascular, ischemic, or inflammatory. Lumbar puncture was unremarkable. CT and spinal angiogram failed to reveal vascular cause. Extensive serologic testing was unrevealing. Mild improvement with IV-steroids and plasmapheresis, suggesting possible inflammatory cause.

Setting: acute inpatient rehabilitation centerAssessment/

Results: He was transferred to inpatient rehab hospital at supervision level with wheelchair for mobility, min assist x1 for transfers and toileting, min-mod assist for dressing, and dependent for bathing. He participated in the spinal cord injury (SCI) therapy program with bodyweight support systems and made progress towards goal of mod-independent level with wheelchair. He was educated on intermittent catheterization program (ICP) and learned to perform self-catheterizations. He regained bowel continence. Neuropathic pain was controlled with pregabalin. His mood remained positive and optimistic.

Discussion: Transverse myelitis is an immune-mediated process that causes injury to the spinal cord. It is now known that COVID-19 can cause neurologic disease including Guillain-Barre, and there are limited case reports demonstrating an association with transverse myelitis. Given etiology in this case remained unclear, it very well could be related to his COVID-19 infection. His progress in rehab shows that an SCI-focused therapy program was beneficial to his care and function.

Conclusion: This case may represent transverse myelitis as a sequela of infection with COVID-19 and demonstrates that these patients may strongly benefit from participation in rehab.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transverse-myelitis-of-unknown-etiology-6-months-after-covid-19-infection-a-case-report/