Disclosures: Kaila T. Yeste, DO: No financial relationships or conflicts of interest

Case Description: Recognizing necrotic transverse myelitis in a critically-ill patient and understanding the prognosis. Appreciating the interdisciplinary approach to the care of teenagers with spinal cord injury and concurrent mental illness.

Setting: Acute inpatient rehabilitation

Patient: A 16-year-old male with a history of autism spectrum disorder who presented to the Emergency Department with second and third-degree burns of 66% total body surface area from self-inflicted injury in an attempt to commit suicide. Assessment/

Results: The patient underwent imaging for bilateral lower extremity clonus discovered one month after initial admission. MRI of the brain and spine showed cord malacia from C6-T1. He underwent IVIG for the possibility of an autoimmune response to his burn injury causing his spinal cord findings; however, his symptoms did not improve. in fact, he remained paraplegic with bowel and bladder dysfunction. His ASIA exam revealed C4 ASIA D. The patient demonstrated difficulty coping with his diagnosis and remained withdrawn from participating in rehab goals including skin integrity, self-catheterization, bowel training, and contracture prevention.

Discussion: The initial care of this patient was appropriately focused on life-saving interventions due to his extensive burn surface area and inhalation injury; therefore, the timing of transverse myelitis is not clear. However, it is hypothesized that there is a relationship between burn injury leading to systemic immune response and transverse myelitis. Special care was taken to educate the patient and family on prognosis, but the patient struggled to accept his acquired injury. In the end, the family felt unable to care for him and he continues to await long-term placement over one year later.

Conclusion: This case describes a patient with transverse myelitis likely related to severe burn injury, which is not well documented in the literature. It also demonstrates how underlying disorders can negatively impact a patient’s recovery and provides recommendations for navigating these unique issues.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/necrotic-transverse-myelitis-following-self-immolation-in-a-teenager/