Transverse myelitis and coronavirus disease 2019 vaccine: A temporal association

ABSTRACT

Background: Transverse myelitis (TM) is most often triggered by an autoimmune reaction due to infections and perhaps vaccines. During the current coronavirus disease 2019 (COVID-19) pandemic, some case reports have shown a temporal association between TM and COVID-19 vaccine. We aimed to report a case of TM with a temporal association with ChAdOx1 nCoV-19 (AZD1222, Oxford/AstraZeneca) vaccine in a Brazilian public hospital. Case Presentation A 27-year-old woman experienced fever, low back pain and urinary retention 3 weeks after the first dose of the ChAdOx1 nCoV-19 vaccine. Two days later, she experienced decreased strength of the lower limbs associated with paresthesia of the distal extremities. At the hospital, there was progression of weakness associated with anesthesia in T4-L1. Magnetic resonance imaging findings were suggestive of demyelination and acute inflammation. Cerebrospinal fluid analysis showed monomorphonuclear pleocytosis, increased protein and decreased glucose. Gram stain, oligoclonal bands, anti-aquaporin-4 antibody, and screening for infectious agents and connective tissue disease were all negative. During treatment, the patient received 5-day pulse therapy with methylprednisolone, acyclovir and 7-day plasmapheresis. Despite all treatments, she persisted with lower limb plegia, areflexia and anesthesia at the level of T4. She was discharged with a monthly cyclophosphamide plan and outpatient follow up. Conclusions: In the absence of other causes, the diagnosis of TM was made with evidence of a possible temporal association with ChAdOx1 nCoV-19 vaccine. It is important to emphasize that it is a temporal association only and the benefits of vaccination continue to outweigh the risk of TM. © 2021 Japanese Society for Neuroimmunology