Disclosures: Dylan W. Banks, BA: No financial relationships or conflicts of interest

Case Diagnosis: COVID-19 vaccine induced acute myelitis.

Case Description: An 81-year-old female patient presented with neurogenic bowel and bladder as well as weakness and numbness in her upper and lower extremities. It was found that autonomic symptoms developed just six days following her first dose of the COVID-19 vaccine, and musculoskeletal symptoms twelve days following. The onset of weakness and numbness occurred over the course of approximately three hours and resulted in incomplete quadriplegia, most prominent in her lower extremities. Extensive testing including cerebrospinal fluid cell count, cytology, and Mayo paraneoplastic panel was inconclusive. Magnetic resonance imaging (MRI) of the cervical spine with contrast showed short segment non-enhancing T2 hyperintense cervical cord lesions with restricted diffusion and cord expansion ranging from C5-C7, consistent with acute myelitis.

Setting: Neuro-rehabilitation unitAssessment/

Results: In the case discussed, the COVID-19 vaccine was a probable trigger for the development of acute myelitis in an otherwise healthy woman who developed neurogenic bowel and bladder as well as incomplete quadriplegia following her first dose of the COVID-19 vaccine. Comprehensive therapy provided in the neuro-rehabilitation unit was essential to the continued recovery for this patient.

Discussion: Treatment for acute myelitis consisted of IV Solu-Medrol followed by plasma exchange (PLEX). The patient was then transferred to the neuro-rehabilitation unit where she participated in physical and occupational therapy. Over the course of 5 weeks, subtle improvement in strength has been noted including improvement of grip strength as well as return of right lower extremity antigravity movement. Additionally, she has regained bowel control. Upon discharge, this patient will require home assist or transfer to a skilled nursing facility.

Conclusion: This case highlights the role neuro-rehabilitation units serve in the rehabilitation of patients who have developed unexpected complications secondary to the COVID-19 pandemic.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-acute-myelitis-secondary-to-covid-19-vaccine-a-case-report/