Disclosures: David A. Finch: No financial relationships or conflicts of interest

Case Diagnosis: A 66-year-old man with past medical history significant for alcohol use disorder, thoracic aortic aneurysm, and alcohol-induced peripheral neuropathy presented with transverse myelitis following COVID-19 mRNA-1273 vaccination.

Case Description or Program Description: The patient presented with a 3 week history of gait dysfunction and bilateral lower extremity weakness while walking, following the second dose of his COVID-19 vaccination. The patient described his leg symptoms as a “squeezing” heaviness that caused tightness, pain, and weakness with walking, without paresthesias. Thoracic spine MRI demonstrated a probable demyelinating process at the T2-T4 levels.

Setting: Tertiary care hospital

Assessment/Results: This patient was diagnosed with transverse myelitis. By day 3 of his hospital stay, the patient started twice daily IV methylprednisolone. By day 4 of his hospital course, the patient’s symptoms had improved (normal neurologic exam), and he underwent a diagnostic lumbar puncture showing no abnormalities. By day 7, the patient was discharged home with home health PT.

Discussion (relevance): The patient’s onset of bilateral lower extremity weakness and stiffness following a vaccination, accompanied by imaging suggestive of thoracic spine demyelination, all suggests a diagnosis of transverse myelitis following his COVID-19 vaccination. Transverse myelitis following COVID-19 vaccination exists as a rare but important adverse event, with 21 cases occurring to date after the mRNA-1273 vaccine, and neurologic symptoms making up 2.69% of all COVID-19 vaccination adverse effects. These events may occur due to several mechanisms observed in neurologic effects of other viral vaccines, such as vaccine-induced elevations in IL-6 & IL-17 levels or adjuvant proteins causing MHC class 1 reactivity to the spinal cord.

Conclusions: Transverse myelitis is a rare yet severe adverse event after the mRNA-1273 COVID-19 vaccine. As this vaccine approaches FDA approval, further study is needed to characterize the mechanism of the event and the susceptibility of specific populations to that mechanism.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracic-transverse-myelitis-following-covid-19-vaccination-a-case-report/