COVID-19 associated myelitis: A case series

Abstract

Spinal cord involvement in COVID-19 infections can be varied and may present as acute transverse myelitis, acute necrotizing myelitis, neuromyelitis optica spectrum disorder, Myelin oligodendrocyte-associated glycoprotein (MOG) antibody myelitis, and SARS-CoV-2 myelitis. We retrospectively analyzed eight cases of COVID-19-associated myelitis. All patients had only mild antecedent symptoms of COVID-19 infection and were admitted with clinical features of acute transverse myelitis confirmed on neuroimaging. Seven patients had longitudinally extensive transverse myelitis (LETM). Serum Aquaporin-4 antibodies (NMO), cerebrospinal fluid (CSF) oligoclonal bands, and RT PCR for COVID-19 were negative. Serum MOG antibodies were positive in three patients; out of this two had CSF pleocytosis. All patients were treated with steroids followed by plasmapheresis. Five cases showed good improvement (increase in power by grade 2 or more), while three cases that were MOG positive had poor outcomes with either minimal or no improvement. The severity of COVID-19 infection was not related to the development of myelitis. Seven cases had LETM. Response to therapy was not uniform and the presence of MOG antibodies and CSF pleocytosis was associated with poor outcomes.

Keywords

• acute transverse myelitis
• covid-19
• myelin associated glycoprotein