Encephalomyelitis Associated With Coronavirus Disease 2019

A Case Report

Riwanti Estiasari; Kartika Maharani; Fitri Octaviana; Anyelir Nielya Mutiara Putri; Syifa Laila Ramadhan; Anna Rozaliani; Darma Imran

Disclosures

J Med Case Reports. 2022;16(329) 

In This Article

Abstract and Introduction

Abstract

Background: Despite a considerable number of articles regarding neurological manifestations associated with severe acute respiratory syndrome coronavirus 2 infection, reports on transverse myelitis and encephalitis are scarce.

Case Presentation: We report a 35-year-old Asian Arab female presenting with longitudinally extensive transverse myelitis within 3 weeks after being diagnosed with mild coronavirus disease 2019 infection. Administration of high-dose methylprednisolone led to significant clinical improvement. However, 2 days after discharge, the patient was readmitted with encephalitis manifestations, consisting of fever and loss of consciousness, along with deterioration in myelitis symptoms. Severe acute respiratory syndrome coronavirus 2 antibody was detected in cerebrospinal fluid, but DNA of severe acute respiratory syndrome coronavirus 2 was not found. Clinical recovery was achieved after the administration of intravenous immunoglobulin.

Conclusion: Longitudinally extensive transverse myelitis can be a neurological manifestation of coronavirus disease 2019 and can be followed by encephalomyelitis episodes. High-dose steroids and intravenous immunoglobulin as an immunomodulator are possible effective treatment options.

Introduction

Neurologic involvement in patients with coronavirus disease 2019 (COVID-19) has been documented extensively, with the most prevalent self-reported neurological complaints being relatively mild, such as headache, hyposmia, and hypogeusia. Examples of uncommon nervous system disorders in this population include, but are not limited to, stroke, acute myelitis, and encephalitis.[1] Acute transverse myelitis, which by itself is a rare neurological condition, has been described to be associated with COVID-19 in various countries; however, the evidence is largely in the form of case reports or series.[2,3] In addition, a global report showed that, among the neurological signs and/or syndromes encountered, meningitis and/or encephalitis and myelopathy were the least frequently found, occurring in 0.1% and 0.2% of hospitalized patients with COVID-19, respectively.[4] Acute disseminated encephalomyelitis (ADEM), a subtype of encephalitis correlated with poor recovery and high mortality, has also been increasingly reported in these patients.[5] In this article, we present a rare case of longitudinally extensive transverse myelitis (LETM) occurring as a parainfectious manifestation of COVID-19 followed by encephalitis in a female patient. Previous publications have noted LETM and post-COVID encephalomyelitis occurring on separate occasions, but only a few patients developed both.[2,6,7]

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