Disclosures: Kurt D. Wilhelm, MD: No financial relationships or conflicts of interest

Case Diagnosis: Rare Diagnosis of Para-Infectious SARS-COV2 Associated Acute Transverse Myelitis Based Off Clinical Presentation and CSF Studies with Negative Imaging

Case Description or Program Description: Patient was admitted for two weeks of ascending paresthesias and weakness of his lower extremities around ten days after recovering from a mild SARS-COV2 associated illness. While in the hospital, his weakness progressed to flaccid paralysis of his lower extremities with a sensory level at T10. Initial workup including magnetic resonance imaging (MRI) of his brain, cervical, thoracic and lumbar spine were negative. Initial electrodiagnostic (EMG) testing was unrevealing. He received a course of intravenous immunoglobulins followed by a five day course of intravenous solumedrol, both of which did not result in any improvement. Multiple weeks into admission, the patient began to exhibit hand intrinsic weakness and paresthesias, so plasmapheresis was attempted without any change in his symptoms.

Setting: Major Academic and Referral Center with Level 1 Adult Trauma

Assessment/Results: After admission to our inpatient rehabilitation unit, repeat MRIs of his cervical and thoracic spine were again unrevealing. Initial cerebrospinal fluid analysis showed lymphocytic pleocytosis, elevated protein and positive oligoclonal bands (2). Repeat EMG obtained after his upper extremity symptoms began did not reveal a cause for his weakness. Inflammatory and neoplastic workups were negative. He also developed upper motor neuron signs on neurological examination late in his admission.

Discussion (relevance): There are documented cases of neurologic complications, specifically transverse myelitis, associated with the multi-systemic inflammatory/immunological response in the post-infectious period of SARS-COV2. What is exceedingly rare, but documented, is a diagnosis based on clinical presentation, elevated CSF protein and lymphocytes alone with the exclusion of other diagnoses.

Conclusions: The neurologic complications of SARS-COV2 in the post-infectious period include transverse myelitis and in rare cases like this, can present without the typical findings seen on imaging of the spinal cord.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rare-diagnosis-of-para-infectious-sars-cov2-associated-acute-transverse-myelitis-based-off-clinical-presentation-and-csf-studies-with-negative-imaging-a-case-report/