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Abstract Details

Acute Transverse Myelitis as a Parainfectious Manifestation of SARS-CoV-2 Infection
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
067
We present a case of acute transverse myelitis associated with presumed Covid-19 infection.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a single-stranded RNA virus that causes coronavirus disease 2019 (COVID-19). The full spectrum of neurological involvement of Covid-19 has not been characterized.
Case report and review of literature.
A 52-year-old man from New York City with hypertension, diabetes, and diabetic peripheral neuropathy presented after two days of progressive bilateral leg weakness and urinary retention. He reported fever, cough, and low back pain that started three weeks prior to this presentation. On arrival, he was febrile and hypoxic on room air (SpO2 88%). Neurological examination showed bilateral hip flexion weakness (Medical Research Council grade 3/5), stable length-dependent sensory loss in the lower extremities, and generalized hyporeflexia. Laboratory studies were notable for leukocytosis (15.9 103/uL), lymphopenia (13%), hyponatremia (126 mmol/L), and elevated inflammatory markers: Lactate dehydrogenase (390 IU/L), erythrocyte sedimentation rate (120 mm/hr), C-reactive protein (195 mg/L), and interleukin-2 receptor (1383 pg/mL). Chest radiography revealed interstitial opacities in both lungs. Magnetic resonance imaging of the total spine revealed increased T2 signal in the spinal cord at the level of the T3 vertebra (Figure 1B-D). Cerebrospinal fluid (CSF) analysis revealed normal cell count (1 cell/mL) with elevated protein (91 mg/dL) and negative RT-PCR for SARS-COV-2. Early mobility was encouraged and antipyretics successfully controlled the patient’s fever. Spontaneous voiding returned on day three of hospitalization. His respiratory status also improved, and he was discharged home.

Neuroinvasion has been demonstrated to be a common feature of many coronaviruses. This case provides insight into the potential mechanisms by which SARS-CoV-2 can affect the central nervous system, highlights acute transverse myelitis as a neurological manifestation of Covid-19, and demonstrates an example of an affected individual with good potential for neurologic recovery.
Authors/Disclosures
Eduard H. Valdes, MD (Columbia University Irving Medical Center)
PRESENTER 		Dr. Valdes has received research support from a T32 NIH Grant.
Elina Zakin, MD, FÂ鶹´«Ã½Ó³»­ (NYU Grossman School of Medicine) The institution of Dr. Zakin has received research support from American Board of Psychiatry and Neurology.