Possible association of demyelination disease with new COVID19 infection

ABSTRACT

Objective: NA Background: Serious neurological complications of SARS-CoV-2 are increasingly being recognized. It involves multiple organs of infected individuals with different clinical manifestations. We report a case of acute transvers myelitis (TM) associated with myelin oligodendrocyte glycoprotein (MOG) antibody possibly induced by COVID-19. Design/Methods: Our case is 72-year-old, male with no significant past medical history Presented with subacute-chronic progressive ascending weakness evolving to flaccid quadriplegia sparing the face with urinary and stool incontinence. He has history of COVID-19 infection 2 months prior to his presentation, manifested with fever and diarrhea and he did not require hospitalization. His initial neurological examination revealed weakness of lower limb more than upper limb with diminished reflexes, sensory level at L2/L3 and bilateral up-going planters. MRI spine with contrast revealed extensive longitudinal transverse myelitis extending from medulla oblongata to mid thoracic segment with no enhancement or cord atrophy Lumbar puncture done which was positive for oligo-clonal band, Anti-MOG antibody and negative AQP4-IgG. He received a full course of methylprednisolone and IVIG followed by plasma exchange for 7 days with minimal improvement only. Results: NA Conclusions: In conclusion, Demyelinating antibodies like MOG-IgG and AQP4-IgG should be tested in the setting of a suspicious clinical picture, such as longitudinally extensive myelitis or severe optic neuritis. This case expands the spectrum of autoimmune and infectious neurological complications of COVID-19.