Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report

Abstract

Background Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine. Case presentation We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment. Conclusion LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

COVID-19 Vaccination and the Rate of Immune and Autoimmune Adverse Events Following Immunization: Insights From a Narrative Literature Review

“…The longitudinally extensive TM (LETM) is a rare subtype of TM, in which the damage extends over 3 or more vertebrae (83). Reports regarding the LETM subtype started to emerge following the worldwide distribution of the COVID-19 vaccines (84)(85)(86)(87)(88). All cases occurred in patients under 60 years of age who presented with neurological symptoms starting within 3 weeks of receiving the first dose of the ChAdOx1 vaccine.…”

Clinical characteristics, radiological features and prognostic factors of transverse myelitis following COVID-19 vaccination: A systematic review

“…The PRISMA flowchart ( Figure 1 ) showed a search strategy for our review. The present study consisted of 28 studies, including 26 case reports, one case series, and one cross-sectional, and the pooled data of 31 patients with COVID-19 vaccine-associated ATM is extracted ( Sriwastava et al, 2021 , Sepahvand et al, 2022 , Tan et al, 2021 , Corrêa et al, 2021 , Vegezzi et al, 2021 , Hsiao et al, 2021 , Pagenkopf and Südmeyer, 2021 , Notghi et al, 2021 , Gao et al, 2021 , Malhotra et al, 2021 , Khan et al, 2022 , Erdem et al, 2021 , Hirose et al, 2021 , Tahir et al, 2021 , Miyaue et al, 2021 , Fujikawa et al, 2021 , Kaulen et al, 2022 , McLean and Trefts, 2021 , Alabkal et al, 2021 , Fitzsimmons and Nance, 2021 , Nakano et al, 2022 , Spataro et al, 2022 , Cabral et al, 2022 , Khan et al, 2022 , Maroufi et al, 2022 , Eom et al, 2022 , Netravathi et al, 2022 , Esechie et al, 2022 ). All of the selected studies were written in the English language.…”

Cervical Transverse Myelitis Following COVID-19 Vaccination

“…Transverse myelitis is a rare phenomenon with an estimated incidence of between 1.34 and 4.6 cases per million annually. 8 ) Several TM cases reportedly occurred following administration of different vaccines, such as hepatitis B virus, human papillomavirus, seasonal influenza, measles-mumps-rubella, polio, and diphtheria, that occurred from a few days to 3 months after vaccination. 12 ) Currently, over ten cases of TM-associated COVID-19 vaccination have been reported.…”

“…Molecular mimicry, epitope spreading, or polyclonal activation of B lymphocytes are possible mechanisms. 8 , 12 ) Bhat et al reported an association between TM and autoimmune diseases. 16 ) Our patient had no history of autoimmune diseases, but an anti-SSA antibody associated with Sjögren's syndrome was elevated.…”