Abstract:Background and Objectives:Neurological manifestations of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2, COVID-19) infection are common and varied. The objective of this report is to describe clinicopathological findings of rare acute ascending necrotizing myelitis (ANM) and briefly summarize similar COVID-19-associated longitudinally extended transverse myelitis (LETM) cases.Methods:We describe the clinical presentation, disease course, diagnostic workup, therapeutic measures, and pathological findings of ANM associated with COVID-19 infection.Results:A 31-year-old previously healthy woman developed a longitudinally extensive lower thoracic myelopathy three weeks after COVID-19 infection. The thoracic spinal cord lesion extended to cervical level in one week and then to the lower medullary level in two more weeks. Thoracic laminectomy at T5 – T6 level and cord biopsy revealed necrobiotic changes without viral particles or microglial nodules. The clinical deficit stabilized following immunomodulatory and eculizumab therapy.Conclusion:COVID-19 infection can cause ascending necrotizing myelitis. It adds to the spectrum of reported cases of COVID-19-associated encephalitis and myelitis.