Top

Published in:

Open Access 01-12-2022 | SARS-CoV-2 | Case report

Encephalomyelitis associated with coronavirus disease 2019: a case report

Authors: Riwanti Estiasari, Kartika Maharani, Fitri Octaviana, Anyelir Nielya Mutiara Putri, Syifa Laila Ramadhan, Anna Rozaliani, Darma Imran

Published in: Journal of Medical Case Reports | Issue 1/2022

Abstract

Background

Despite a considerable number of articles regarding neurological manifestations associated with severe acute respiratory syndrome coronavirus 2 infection, reports on transverse myelitis and encephalitis are scarce.

Case presentation

We report a 35-year-old Asian Arab female presenting with longitudinally extensive transverse myelitis within 3 weeks after being diagnosed with mild coronavirus disease 2019 infection. Administration of high-dose methylprednisolone led to significant clinical improvement. However, 2 days after discharge, the patient was readmitted with encephalitis manifestations, consisting of fever and loss of consciousness, along with deterioration in myelitis symptoms. Severe acute respiratory syndrome coronavirus 2 antibody was detected in cerebrospinal fluid, but DNA of severe acute respiratory syndrome coronavirus 2 was not found. Clinical recovery was achieved after the administration of intravenous immunoglobulin.

Conclusion

Longitudinally extensive transverse myelitis can be a neurological manifestation of coronavirus disease 2019 and can be followed by encephalomyelitis episodes. High-dose steroids and intravenous immunoglobulin as an immunomodulator are possible effective treatment options.

Nepal G, Rehrig JH, Shrestha GS, Sing YK, Yadav JK, Ojha R, et al. Neurological manifestations of COVID-19: a systematic review. Crit Care. 2020;24:421. https://doi.org/10.1186/s13054-020-03121-z.CrossRefPubMedPubMedCentral

Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute transverse myelitis (ATM): clinical review of 43 patients with COVID-19-associated ATM and 3 post-vaccination ATM serious adverse events with the ChAdOx1 nCoV-19 vaccine (AZD1222). Front Immunol. 2021;12: 653786. https://doi.org/10.3389/fimmu.2021.653786.CrossRefPubMedPubMedCentral

Schulte EC, Hauer L, Kunz AB, Sellner J. Systematic review of cases of acute myelitis in individuals with COVID-19. Eur J Neurol. 2021;28:3230–44. https://doi.org/10.1111/ene.14952.CrossRefPubMedPubMedCentral

Chou SHY, Beghi E, Helbok R, Moro E, Sampson J, Altamirano V, et al. Global incidence of neurological manifestations among patients hospitalized with COVID-19—a report of the GCS-NeuroCOVID consortium and the ENERGY consortium. JAMA Netw Open. 2021;4(5): e2112131. https://doi.org/10.1001/jamanetworkopen.2021.12131.CrossRefPubMedPubMedCentral

Siow I, Lee KS, Zhang JJY, Saffari SE, Ng A. Encephalitis as a neurological complication of COVID-19: a systematic review and meta-analysis of incidence, outcomes, and predictors. Eur J Neurol. 2021;28:3491–502. https://doi.org/10.1111/ene.14913.CrossRefPubMedPubMedCentral

Baghbanian SM, Namazi F. Post COVID-19 longitudinally extensive transverse myelitis (LETM)—a case report. Acta Neurol Belg. 2020. https://doi.org/10.1007/s13760-020-01497-x.CrossRefPubMedPubMedCentral

Kim JW, Abdullayev N, Neuneier J, Fink GR, Lehmann HC. Post-COVID-19 encephalomyelitis. Neurol Res Pract. 2021. https://doi.org/10.1186/s42466-021-00113-4.CrossRefPubMedPubMedCentral

Harvey CM, Gottipati R, Schwarz S, Auer D, O’Donoghue M, Russell NH, et al. Acute disseminated encephalomyelitis following allo-SCT: central nervous system manifestation of GVHD. Bone Marrow Transplant. 2014;49:854–6. https://doi.org/10.1038/bmt.2014.29.CrossRefPubMed

Anilkumar AC, Foris LA, Tadi P. Acute disseminated encephalomyelitis. In: StatPearls. Treasure Island (FL); Started Publishing: 2021. https://www.ncbi.nlm.nih.gov/books/NBK430934/. Accessed 19 Jul 2021.

10.

Kim SM, Kim SJ, Lee HJ, Kuroda H, Palace J, Fujihara K. Differential diagnosis of neuromyelitis optica spectrum disorder. Ther Adv Neurol Disord. 2017;10(7):265–89. https://doi.org/10.1177/1756285617709723.CrossRefPubMedPubMedCentral

11.

Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020;267(10):2799–802.CrossRef

12.

Fumery T, Baudar C, Ossemann M, London F. Longitudinally extensive transverse myelitis following acute COVID-19 infection. Multiple Scler Relat Disord. 2021;48: 102723.CrossRef

13.

Ashfaq MA, Javed I, Arshad M, Yaseen MR. Role of methylprednisolone in longitudinal extensive transverse myelitis (LETM) in children. Pak J Med Sci. 2020;36(3):451–5. https://doi.org/10.12669/pjms.36.3.1232.CrossRefPubMedPubMedCentral

14.

Alexopoulos H, Magira E, Bitzogli K, Kafasi N, Vlachoyiannopoulos P, Tzioufas A, et al. Anti-SARS-CoV-2 antibodies in the CSF, blood–brain barrier dysfunction, and neurological outcome. Neurol Neuroimmunol Neuroinflamm. 2020;7: e893. https://doi.org/10.1212/NXI.0000000000000893.CrossRefPubMedPubMedCentral

15.

Song E, Bartley CM, Chow RD, Ngo TT, Jiang R, Zamecnik CR, et al. Divergent and self-reactive immune responses in the CNS of COVID-19 patients with neurological symptoms. Cell Rep Med. 2021;2(5): 100288. https://doi.org/10.1016/j.xcrm.2021.100288.CrossRefPubMedPubMedCentral

16.

Muccioli L, Pensato U, Bernabe G, Ferri L, Tappata M, Volpi L, et al. Intravenous immunoglobulin therapy in COVID-19-related encephalopathy. J Neurol. 2021;268:2671–5. https://doi.org/10.1007/s00415-020-10248-0.CrossRefPubMed

Title: Encephalomyelitis associated with coronavirus disease 2019: a case report
Authors: Riwanti Estiasari
Kartika Maharani
Fitri Octaviana
Anyelir Nielya Mutiara Putri
Syifa Laila Ramadhan
Anna Rozaliani
Darma Imran
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: SARS-CoV-2
COVID-19
Encephalitis
Published in: Journal of Medical Case Reports / Issue 1/2022
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-022-03539-9

At a glance: The STEP trials

Springer Medicine

Encephalomyelitis associated with coronavirus disease 2019: a case report

Abstract

Background

Case presentation

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report

Masked diabetes insipidus in pituitary metastasis from breast cancer after thalamic biopsy: a case report

Primary retroperitoneal hydatid cyst with intraperitoneal rupture: a case report

Isolated adrenocorticotropic hormone deficiency and sialadenitis associated with nivolumab: a case report

A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee–chest positioning on extreme undernourishment: a case report and review of the literature

Varicella zoster-associated progressive lower cranial and upper cervical polyneuropathy: a case report