MOG-antibody-associated longitudinal extensive myelitis after ChAdOx1 nCoV-19 vaccination

This case report describes a 59-year-old man with myelin oligodendrocyte glycoprotein (MOG)-positive longitudinal extensive transverse myelitis (LETM) after being vaccinated with the COVID-19 vaccine ChAdOx1 nCoV-19. He presented with urinary retention, gait disturbance, hypoesthesia and brisk reflexes in his lower extremities without paresis. Due to the ineffectiveness of high-dose intravenous methylprednisolone, therapeutic plasma exchange was performed, gradually improving the patient’s condition. Vaccination as a trigger for an excessive immunological response seems plausible, though unspecific for the ChAdOx1 nCoV-19 vaccine.

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P.049 Medically refractory longitudinally extensive transverse myelitis successfully treated with cyclophosphamide induction

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.153 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S32-S33

Author(s):

LJ Baxter ◽

S Chen ◽

JM Burton

Keyword(s):

Respiratory Failure ◽

Plasma Exchange ◽

Immune Therapy ◽

Transverse Myelitis ◽

Acute Disseminated Encephalomyelitis ◽

High Dose ◽

Longitudinally Extensive Transverse Myelitis ◽

Intravenous Methylprednisolone ◽

Intensive Care Admission ◽

Extensive Transverse Myelitis

Background: Longitudinally extensive transverse myelitis (LETM) is a demyelinating condition that is associated with diseases such as neuromyelitis optica spectrum disorder (NMOSD), acute disseminated encephalomyelitis, collagen vascular disease, or can be idiopathic. LETM can be severe enough to cause quadraparesis, marked sensory dysfunction, and respiratory failure. Rarely, these patients are unresponsive to conventional immune therapy. Methods: We report two cases of severe LETM with acute development of quadraparesis and respiratory failure requiring intensive care admission and failure to respond to high-dose corticosteroids, plasma exchange, IVIg and rituximab. Disease cessation and ultimately, significant recovery, was achieved after an 8-day cyclophosphamide induction. Results: A 21 yo female with antibody positive NMOSD and a 19 yo male with idiopathic LETM remained quadraparetic and ventilator dependent with active MRIs despite multiple courses of intravenous methylprednisolone, plasma exchanges, and in the NMOSD patient, IVIg and a 4-week course of rituximab. Both patients ultimately improved significantly and are now ambulatory with subsequent cyclophosphamide induction. Conclusions: In patients with severe LETM of presumed immune origin, who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered. This agent provides a more robust immunosuppressive response and can be induced rapidly. Cyclophosphamide effects and supportive evidence are further discussed.

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Anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive varicella-zoster virus myelitis presenting as longitudinally extensive transverse myelitis: a case report

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-001066 ◽

2017 ◽

Vol 57 (10) ◽

pp. 579-583 ◽

Cited By ~ 5

Author(s):

Yuji Shiga ◽

Teppei Kamimura ◽

Yutaka Shimoe ◽

Toshiyuki Takahashi ◽

Kimihiko Kaneko ◽

...

Keyword(s):

Case Report ◽

Varicella Zoster Virus ◽

Transverse Myelitis ◽

Myelin Oligodendrocyte Glycoprotein ◽

Longitudinally Extensive Transverse Myelitis ◽

Varicella Zoster ◽

Extensive Transverse Myelitis

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Longitudinally extensive transverse myelitis involving fifteen vertebral bodies positive for anti-myelin oligodendrocyte glycoprotein (MOG) antibody: a case report

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-001290 ◽

2019 ◽

Vol 59 (6) ◽

pp. 375-378 ◽

Cited By ~ 1

Author(s):

Takeshi Imai ◽

Souichirou Shibata ◽

Kensuke Shinohara ◽

Kenzo Sakurai ◽

Masahiro Horiuchi ◽

...

Keyword(s):

Case Report ◽

Transverse Myelitis ◽

Myelin Oligodendrocyte Glycoprotein ◽

Longitudinally Extensive Transverse Myelitis ◽

Vertebral Bodies ◽

Extensive Transverse Myelitis

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Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report

BMC Neurology ◽

10.1186/s12883-021-02427-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wee Yong Tan ◽

Abdul Hanif Khan Yusof Khan ◽

Mohd Naim Mohd Yaakob ◽

Anna Misyail Abdul Rashid ◽

Wei Chao Loh ◽

...

Keyword(s):

Transverse Myelitis ◽

Neurological Complications ◽

High Dose ◽

Sensory Level ◽

Limb Weakness ◽

Efficacy Trials ◽

First Case ◽

Longitudinal Extensive Transverse Myelitis ◽

Magnetic Resonance Imaging Mri ◽

Extensive Transverse Myelitis

Abstract Background Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine. Case presentation We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment. Conclusion LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

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Longitudinally Extensive Transverse Myelitis (LETM) and Myopericarditis in a 7-Month-Old Child with SARs-CoV-2 Infection

Neuropediatrics ◽

10.1055/s-0041-1732364 ◽

2021 ◽

Author(s):

Giacomo Brisca ◽

Stefano Sotgiu ◽

Daniela Pirlo ◽

Barbara Tubino ◽

Laura Siri ◽

...

Keyword(s):

Cardiac Involvement ◽

Transverse Myelitis ◽

Acute Disseminated Encephalomyelitis ◽

Neurological Complications ◽

Nasopharyngeal Swab ◽

High Dose ◽

Longitudinally Extensive Transverse Myelitis ◽

Permanent Disability ◽

Longitudinal Extensive Transverse Myelitis ◽

Extensive Transverse Myelitis

Abstract Introduction In the last few months, some pediatric cases with neurological and neuroradiological pictures related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported, often associated with multisystem inflammatory syndrome (MIS-C). The most frequently encountered pediatric neurological complications seem to be postinfectious immune-mediated acute disseminated encephalomyelitis (ADEM)-like changes of the brain, myelitis, neural enhancement, and splenial lesions. Concomitant neurological and cardiac involvement has been reported only in MIS-C, although specific clinical details are often not fully available. Methods In this case report, a very young child infected with SARs-CoV-2 and diagnosed as longitudinal extensive transverse myelitis with concomitant myo-pericarditis is presented. Results A previously healthy 7-month-old girl presented with abrupt onset of generalized weakness with inability to sit up. She had had mild respiratory symptoms 1 week earlier. Spinal magnetic resonance imaging (MRI) showed a T2-hyperintense intramedullary lesion extending from C4 to T2, compatible with acute longitudinally extensive transverse myelitis (LETM). Cerebrospinal fluid analysis was negative.Echocardiography and blood tests were suggestive for myo-pericarditis. Real time polymerase chain reaction for SARS-CoV-2 on nasopharyngeal swab sample tested positive. She was promptly treated with high dose of steroids and immunoglobulin with satisfactory clinical response. Conclusion To the evolving literature of neurological complications of SARs-CoV-2 infection, we add the youngest patient described to date with isolated LETM and concomitant cardiac involvement. Our case suggests that clinicians should be aware of this association, although difficult to recognize in infants. Practitioners are encouraged to consider aggressive first-line immunotherapies with the final aim to prevent permanent disability.

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Refractory Longitudinally Extensive Transverse Myelitis Responsive to Cyclophosphamide

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.201 ◽

2017 ◽

Vol 44 (6) ◽

pp. 736-739

Author(s):

Laura J. Baxter ◽

Shuo Chen ◽

Philippe Couillard ◽

James N. Scott ◽

Christopher J. Doig ◽

...

Keyword(s):

Intensive Care ◽

Plasma Exchange ◽

Immune Therapy ◽

Transverse Myelitis ◽

High Dose ◽

Supportive Evidence ◽

Longitudinally Extensive Transverse Myelitis ◽

Intensive Care Admission ◽

Immune Mediated ◽

Extensive Transverse Myelitis

AbstractSevere longitudinally extensive transverse myelitis (LETM) can cause quadriplegia, marked sensory dysfunction, and respiratory failure. Some patients are unresponsive to conventional immune therapy. We report two cases of severe immune-mediated LETM requiring intensive care admission that failed to respond to high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. Disease cessation and significant recovery was achieved after cyclophosphamide induction. In patients with severe acute immune-mediated LETM who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered. This agent and regimen provides a robust immunosuppressive response and can be induced rapidly. Cyclophosphamide effects and supportive evidence are discussed.

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