Disclosures: Shaohua Xu, MD, PhD: No financial relationships or conflicts of interest

Case Diagnosis: Acute transverse myelitis

Case Description: A 76-year-old right handed previously independent male with history of hypertension, dyslipidemia and myoclonus, developed sudden onset left arm weakness and paresthesia, dizziness and imbalance 20 minutes after he received the second dose of COVID-19 vaccine (BNT162b2, Pfizer-BioNTech) in his left deltoid. By the time he presented to the acute care hospital, the weakness and paresthesia had progressed to the left lower extremity. Initial MRI brain and C-spine were unremarkable. Repeat MRI C-spine 4 days later revealed interval development of T2 hyperintensity and restricted diffusion of the spinal cord at C3-C4 suggestive of demyelinating transverse myelitis. The patient received 5 days of high-dose Solumedrol and 5 rounds of plasmapheresis during his 17-day acute hospital stay before discharge to inpatient rehab. Upon admission the patient described belt sensation around his waist, left side hemiparesis and significant trunk weakness. Sensation was intact to light touch throughout. Initial activity of daily living (ADL) and mobility evaluation revealed the patient was at a dependent level for dressing, maximal assist for bathing and toileting, moderate assist with oral hygiene, dependent with bed-to-chair transfer, and unable to walk or propel a wheelchair.

Setting: Acute inpatient rehabilitation hospitalAssessment/

Results: After first 18 days of the total expected 28-day inpatient rehab hospital course, the patient gradually improved his functional status to moderate assist level for most ADLs, transfer and ambulation of 40 feet with a rolling walker.

Discussion: This is the first reported case, to our knowledge, of inpatient rehabilitation of a patient with acute myelitis that developed shortly after a full dose of BNT162b2 COVID-19 vaccination.

Conclusion: We described a case of acute myelitis most likely secondary to COVID-19 vaccination with the BNT162b2 vaccine that caused severe functional impairment. The ongoing inpatient rehabilitation has helped the patient to slowly improve in strength, functions of ADLs and mobility.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/inpatient-rehabilitation-for-a-76-year-old-male-with-acute-transverse-myelitis-post-bnt162b2-covid-19-vaccination/