A Case of Transverse Myelitis After Moderna Severe Acute Respiratory Syndrome Coronavirus Vaccination

Abstract

Transverse myelitis (TM) is an inflammatory syndrome of the spinal cord that presents with acute-to-subacute neurological deficits. The differential for TM is broad and includes demyelinating, infectious, neoplastic and paraneoplastic, autoimmune, and metabolic/toxic etiologies. With the novel severe acute respiratory syndrome coronavirus pandemic, more commonly referred to as the coronavirus infectious disease of 2019 (COVID-19), there have been increasing reports of neurological complications. In this case report, we describe a novel case of longitudinally-extensive TM associated with the Moderna vaccination.

Onset of Guillain-Barre Syndrome and Transverse Myelitis Following COVID-19 Vaccination

“…A systematic review that examined literature up to 2020 shared that GBS was reported in 58 different studies following influenza, hepatitis, polio, rubella, measles-rubella, measles-mumps-rubella (MMR), and other types of vaccines [ 10 ]. Similarly, another systematic review demonstrated 37 studies in which TM resulted following MMR, hepatitis B, diphtheria-tetanus-pertussis (DTaP), and other types of vaccines [ 6 , 11 ]. It is hypothesized that the development of neuro-inflammatory syndromes like GBS or TM following COVID-19 or other vaccinations is attributed to molecular mimicry [ 6 ].…”

“…Similarly, another systematic review demonstrated 37 studies in which TM resulted following MMR, hepatitis B, diphtheria-tetanus-pertussis (DTaP), and other types of vaccines [ 6 , 11 ]. It is hypothesized that the development of neuro-inflammatory syndromes like GBS or TM following COVID-19 or other vaccinations is attributed to molecular mimicry [ 6 ]. In this pathway, foreign antigens in the vaccines present similarly to host cells and tissue, where this leads to an immune and inflammatory response that leads to the destruction of both foreign and host structures [ 6 ].…”

“…This disorder may involve demyelination and inflammation of oligodendrocytes, myelin, axons, and even neurons because the white and gray matter of the nervous system is affected [ 5 ]. Patients with this disease may experience gradual muscle sensory loss, motor weakness, and even paralysis [ 6 ]. TM is a rare condition, with one to eight people per 1 million individuals developing the disease annually [ 5 ].…”

“…GBS and TM may both present with similar symptoms and may both coexist in patients following COVID-19 infection and vaccination, known as GBS/TM overlap syndrome [ 4 , 6 , 7 ]. Vaccinations against SARS-CoV-2 are mostly based on the messenger ribonucleic acid (mRNA) and viral vector platforms, where common symptoms following vaccinations include fevers, chills, nausea, headaches, and more [ 8 , 9 ].…”