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

BMC Neurology ◽  
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.

scholarly journals Longitudinally extensive transverse myelitis with seropositive chikungunya

2019 ◽  
Vol 12 (10) ◽  
pp. e231745 ◽  
Author(s):  
Sajid Hameed ◽  
Mubashar Memon ◽  
Hina Imtiaz ◽  
Dureshahwar Kanwar
Keyword(s):  
Transverse Myelitis ◽  
Febrile Illness ◽  
Neurological Complications ◽  
The Other ◽  
Sensory Level ◽  
Low Grade ◽  
Longitudinally Extensive Transverse Myelitis ◽  
First Case ◽  
History Of ◽  
Extensive Transverse Myelitis

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of LETM are reported worldwide in association with CHIKV fever and this is the first case from Pakistan. With frequent chikungunya outbreaks, neurological complications are increasingly seen in clinical practice. The knowledge of these associations will result in their early diagnosis and treatment.

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

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.

Neuromyelitis optica spectrum disorder (NMOSD) presenting as acute transverse myelitis with positive aquaporin 4 antibodies

2021 ◽  
Vol 14 (1) ◽  
pp. e238992
Author(s):  
Katherine Thornley ◽  
Carlo Canepa
Keyword(s):  
Spinal Cord ◽  
Transverse Myelitis ◽  
Aquaporin 4 ◽  
Sensory Level ◽  
Mri Scan ◽  
Acute Transverse Myelitis ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Oral Steroids ◽  
Extensive Transverse Myelitis

An 80-year-old, previously healthy patient presents with acute transverse myelitis with sensory level at T8. The MRI scan of the spinal cord showed longitudinal extensive transverse myelitis, and she tested positive for aquaporin 4 antibodies in serum. She received treatment with intravenous and oral steroids, with no improvement and then underwent plasma exchange. She was then started on azathioprine for prevention of relapses, while continuing physiotherapy and occupational therapy. Eventually, she was transferred to a specialised spinal cord centre for long-term rehabilitation.

scholarly journals Case Report: Longitudinal Extensive Transverse Myelitis With Novel Autoantibodies Following Two Rounds of Pembrolizumab

2021 ◽  
Vol 12 ◽  
Author(s):  
Salma Charabi ◽  
Lotte Engell-Noerregaard ◽  
Anna Christine Nilsson ◽  
Christian Stenör
Keyword(s):  
Death Receptor ◽  
Transverse Myelitis ◽  
Immunofluorescence Assay ◽  
Treatment Regimens ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Neuronal Autoantibodies ◽  
Radiological Response ◽  
Magnetic Resonance Imaging Mri ◽  
Underlying Pathophysiology ◽  
Extensive Transverse Myelitis

A 63-year-old male with metastatic non-small cell lung cancer developed longitudinal extensive transverse myelitis (LETM) following two cycles of Pembrolizumab, an immune checkpoint inhibitor (ICI) targeting the programmed cell death receptor 1 (PD-1). Magnetic resonance imaging (MRI) showed centromedullary contrast enhancement at several levels, cerebrospinal fluid (CSF) cytology showed lymphocytic pleocytosis, and indirect immunofluorescence assay (IFA) on the primate cerebellum, pancreas, and intestine revealed strong binding of neuronal autoantibodies to unknown antigens. CSF C–X–C motif ligand 13 (CXCL13) was elevated. The patient was treated with plasma exchange (PEX) and intravenous (i.v.) methylprednisolone (MP) 1 g/day for 5 days followed by oral (p.o.) MP 100 mg/day for 10 days with clinical and radiological response. However, after discontinuation of MP, LETM relapsed and the patient developed paralytic ileus presumably due to autoimmune enteropathy and suffered a fatal gastrointestinal sepsis. Findings of novel neuronal autoantibodies and highly elevated CXCL13 in CSF suggest that the severe neurological immune-related adverse event (nirAE) was B-cell mediated contrary to the commonly assumed ICI-induced T-cell toxicity. An individual evaluation of the underlying pathophysiology behind rare nirAEs is essential for choosing treatment regimens and securing optimal outcome.

scholarly journals Iatrogenic Kaposi’s sarcoma following immunosuppressive treatment of the recurrent longitudinally extensive transverse myelitis

2018 ◽  
Vol 146 (5-6) ◽  
pp. 312-315
Author(s):  
Jovan Lalosevic ◽  
Dusan Skiljevic ◽  
Irena Dujmovic ◽  
Jelena Drulovic ◽  
Ljiljana Medenica
Keyword(s):  
Immunosuppressive Treatment ◽  
Transverse Myelitis ◽  
Central Nervous System Disease ◽  
Skin Lesions ◽  
Efficient Treatment ◽  
System Disease ◽  
First Case ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Significant Regression ◽  
Extensive Transverse Myelitis

Introduction. Iatrogenic Kaposi?s sarcoma (KS) represents a multifocal, angioproliferative tumor that develops in patients undergoing immunosuppressive treatment and is considered to be induced by activation of latent human herpes virus type 8 (HHV8) infection. The aim of this report is to present a patient with iatrogenic KS due to immunosuppressive treatment. Case outline. We present a 69-year-old male non-HIV patient, previously treated for anti-aquaporin-4 antibody negative recurrent longitudinal extensive transverse myelitis with prednisolone and azathioprine for one year. The patient developed bluish and violet plaques and nodules on his face, trunk, and extremities. Skin biopsy findings (histopathology and immunohistochemical detection of CD31 expression and anti-HHV8 antibodies in the spindle cells) confirmed the diagnosis of KS. The reduction of immunosuppression and topical treatment with imiquimod resulted in a partial but significant regression of skin lesions, but the patient had another relapse of myelitis following the cessation of azathioprine and a reduction in the dose of prednisolone. Conclusion. To the best of our knowledge, this is the first case of an inflammatory and demyelinating central nervous system disease treated with corticosteroids and azathioprine that was associated with iatrogenic KS. The efficient treatment of both conditions is highly challenging and can be troublesome in specific cases.

Acute anosmia in neuromyelitis optica spectrum disorder

2020 ◽  
Vol 26 (14) ◽  
pp. 1958-1960 ◽  
Author(s):  
Joseph Marshall ◽  
Iris Kleerekooper ◽  
Indran Davagnanam ◽  
S Anand Trip
Keyword(s):  
Neuromyelitis Optica ◽  
Area Postrema ◽  
Transverse Myelitis ◽  
Spectrum Disorder ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Resonance Imaging ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Magnetic Resonance Imaging Mri ◽  
Aquaporin 4 Antibody ◽  
Extensive Transverse Myelitis

The cardinal features of neuromyelitis optica spectrum disorder (NMOSD) are optic neuritis, longitudinal extensive transverse myelitis and area postrema syndrome. Olfactory dysfunction is not listed as a feature in the NMOSD diagnostic criteria. Here, we present an aquaporin-4 antibody positive patient who, in addition to classical features of NMOSD, developed acute anosmia with magnetic resonance imaging (MRI) evidence of olfactory bulb abnormalities. While the association of anosmia and NMOSD has been rarely noted previously, to our knowledge, no prior cases have found this to be one of the presenting features of a relapse nor have they identified acute radiological correlates.

scholarly journals Acute longitudinal extensive transverse myelitis secondary to asymptomatic SARS-CoV-2 infection

2021 ◽  
Vol 14 (7) ◽  
pp. e244687
Author(s):  
Gabriel Lee
Keyword(s):  
Lower Limb ◽  
Post Partum ◽  
Rare Complication ◽  
Transverse Myelitis ◽  
Sensory Loss ◽  
Nasopharyngeal Swab ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Extensive Transverse Myelitis

A 35-year-old woman, 6 months post partum, presented with acute onset back pain at the T8 level progressing to bilateral lower limb weakness and sensory loss with urinary retention and constipation. This patient had a pre-existing inflammatory disease, having recently developed ulcerative colitis antenatally. Five days prior to admission, she had tested positive asymptomatically on a SARS-CoV-2 reverse-transcriptase PCR nasopharyngeal swab. The positive swab result was confirmed on admission. Clinical examination revealed bilaterally exaggerated knee reflexes, lower limb weakness and positive Babinski’s sign. Sensation was impaired at L4 and L5 dermatomes and absent at S1 and S2. MRI findings suggested longitudinal extensive transverse myelitis, with multiple regions of patchy hyperintensity seen in the thoracic region of the spinal cord both centrally and peripherally. She was started on a course of intravenous corticosteroids and improvement was seen both clinically and on repeat imaging. This case demonstrates a rare complication to an asymptomatic COVID-19 infection and explores the potential neurotropic properties of COVID-19.

scholarly journals Longitudinal extensive transverse myelitis with sixth nerve palsy post ChAdOx1 nCov-19 vaccine: A case report and literature review

2021 ◽  
Vol 12 (2) ◽  
pp. 526-538
Author(s):  
Abed AlRaouf Kawtharani ◽  
Battoul Fakhry ◽  
Abbass Serhan
Keyword(s):  
Nerve Palsy ◽  
Transverse Myelitis ◽  
Demyelinating Diseases ◽  
Limb Weakness ◽  
Term Care ◽  
Sixth Nerve Palsy ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Post Marketing Surveillance ◽  
Extensive Transverse Myelitis ◽  
Sixth Nerve

Concurrently with the quick development of COVID-19 vaccines globally, concerns about vaccination efficacy and safety are rising. Neurological complications such as transverse myelitis (TM) are major worries because they can cause lifelong disabilities, which may require long term care. Here, we report a case of longitudinal extensive transverse myelitis (LETM), with sixth nerve palsy in a young female occurring shortly after ChAdOx1 nCov-19 vaccine. The patient recalled developing strabismus, progressive ascending bilateral lower limb weakness, along with upper extremity paresthesia, abnormal sensation below T6 dermatomes, and difficulty in urination. She presented to the hospital with complete paralysis below the neck associated with urinary retention. Extensive diagnostic studies were performed to rule out alternative etiologies, including but not limited to demyelinating diseases, para-post infectious agents, paraneoplastic syndromes, tumors, and autoimmune diseases. She was treated with corticosteroids and discharged upon clinical improvement. However, the patient clinically deteriorated and intravenous immunoglobulin was administered. Unfortunately, the patient is still suffering from physical impairment. We suggested that LETM could be induced by an autoimmune process triggered molecule mimicry. In conclusion, safety monitoring of the COVID-19 vaccines is of great importance in the post marketing surveillance, particularly for rare adverse events.

scholarly journals Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Antonina Obayo ◽  
Sylvia Mbugua ◽  
Sayed K. Ali
Keyword(s):  
Cauda Equina ◽  
Transverse Myelitis ◽  
High Dose ◽  
Longitudinally Extensive Transverse Myelitis ◽  
Serological Tests ◽  
Limb Weakness ◽  
Minimal Improvement ◽  
History Of ◽  
Sub Saharan ◽  
Extensive Transverse Myelitis

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

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

2021 ◽  
pp. 135245852110575
Author(s):  
Larissa Dams ◽  
Markus Kraemer ◽  
Jana Becker
Keyword(s):  
Case Report ◽  
Plasma Exchange ◽  
Urinary Retention ◽  
Transverse Myelitis ◽  
Immunological Response ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
High Dose ◽  
Intravenous Methylprednisolone ◽  
Longitudinal Extensive Transverse Myelitis ◽  
Extensive Transverse Myelitis

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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