COVID-19 Myelitis in Contrast to Other Viral Myelitides: A Case Series

ABSTRACT

Case Diagnosis Myelitis Case Description or Program Description In two years, a rehabilitation unit had four distinct cases of viral myelitis. A 67-year-old male with T12 AIS C SCI due to West Nile virus (WNV);a 42-year-old male with L1 AIS C SCI due to Epstein-Barr virus (EBV);a 33-year-old male with L2 AIS D SCI due to varicella zoster virus (VZV);and a 35-year-old male with T10 AIS D SCI secondary to COVID-19. Setting(s) Tertiary Care Hospital Assessment/Results: Each case was notable for severe comorbid encephalitis and had a unique course and outcome. The cases of WNV and VZV acute transverse myelitis (ATM) greatly improved during their rehabilitation course and eventually achieved functional independence. The case of EBV myelitis had continuing functional decline to present. The patient with COVID-19 myelitis presented with paraplegia, initially improved to independent ambulation, then had progressive decline in his lower extremity strength. Discussion (relevance) Viral myelitis is an exceptionally rare cause of SCI, with an estimated incidence of 1-4 per 1 million. Myelitis as a consequence of WNV is exceedingly rare. Literature search revealed this is only the 4th case describing longitudinally extensive ATM from WNV. Myelitis due to EBV is also exceedingly rare, despite EBV being an often benign common viral infection. Among zoster patients, the incidence of myelitis has been reported to be only 0.3%. Incidence of COVID-19 associated myelitis is estimated to be 0.5 per million. Conclusion(s) These cases highlight four distinct etiologies of viral myelitis, with varying patterns of recovery. The patients with WNV and VZV improved significantly, while the patients with EBV and COVID continued to decline. This provides an opportunity to review the presentation of rare etiologies of SCI and promote awareness of WNV, EBV, VZV and COVID-19 as causes of myelitis. This knowledge may improve accuracy of diagnosis and prevent increased morbidity caused by inappropriate treatment.