Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report

BMC Neurol. 2021 Oct 12;21(1):395. doi: 10.1186/s12883-021-02427-x.

Abstract

Background: Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine.

Case presentation: We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment.

Conclusion: LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

Keywords: COVID-19; Case report; Malaysia; Myelitis, transverse; Vaccination.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19 Vaccines
  • COVID-19*
  • ChAdOx1 nCoV-19
  • Female
  • Humans
  • Myelin-Oligodendrocyte Glycoprotein
  • Myelitis, Transverse* / chemically induced
  • SARS-CoV-2
  • Vaccines*

Substances

  • COVID-19 Vaccines
  • Myelin-Oligodendrocyte Glycoprotein
  • Vaccines
  • ChAdOx1 nCoV-19