Thoracic Transverse Myelitis Following COVID-19 Vaccination: A Case Report

ABSTRACT

Case Diagnosis A 66-year-old man with past medical history significant for alcohol use disorder, thoracic aortic aneurysm, and alcohol-induced peripheral neuropathy presented with transverse myelitis following COVID-19 mRNA-1273 vaccination. Case Description or Program Description The patient presented with a 3 week history of gait dysfunction and bilateral lower extremity weakness while walking, following the second dose of his COVID-19 vaccination. The patient described his leg symptoms as a "squeezing" heaviness that caused tightness, pain, and weakness with walking, without paresthesias. Thoracic spine MRI demonstrated a probable demyelinating process at the T2-T4 levels. Setting(s) Tertiary care hospital Assessment/Results: This patient was diagnosed with transverse myelitis. By day 3 of his hospital stay, the patient started twice daily IV methylprednisolone. By day 4 of his hospital course, the patient's symptoms had improved (normal neurologic exam), and he underwent a diagnostic lumbar puncture showing no abnormalities. By day 7, the patient was discharged home with home health PT. Discussion (relevance) The patient's onset of bilateral lower extremity weakness and stiffness following a vaccination, accompanied by imaging suggestive of thoracic spine demyelination, all suggests a diagnosis of transverse myelitis following his COVID-19 vaccination. Transverse myelitis following COVID-19 vaccination exists as a rare but important adverse event, with 21 cases occurring to date after the mRNA-1273 vaccine, and neurologic symptoms making up 2.69% of all COVID-19 vaccination adverse effects. These events may occur due to several mechanisms observed in neurologic effects of other viral vaccines, such as vaccine-induced elevations in IL-6 & IL-17 levels or adjuvant proteins causing MHC class 1 reactivity to the spinal cord. Conclusion(s) Transverse myelitis is a rare yet severe adverse event after the mRNA-1273 COVID-19 vaccine. As this vaccine approaches FDA approval, further study is needed to characterize the mechanism of the event and the susceptibility of specific populations to that mechanism.