Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review

Abstract

Background: Even though SARS-CoV-2 is a predominantly respiratory virus, several reports have described various neurological disorders, from the beginning of the pandemic. The first para-infectious myelitis case was described in Wuhan in February 2020. Nevertheless, data from registries and reviews are scarce. Methods: A 40-year-old female with T5-T6 SARS-CoV-2 para-infectious myelitis is reported. A literature review of the published literature on the SARS-CoV-2 and para-infectious myelitis was done. Epidemiological, clinical, laboratory, image, treatment, and outcome data are described. Results: Particular findings of our case are that Covid-19 was asymptomatic and anti-GD2/GD3 IgM was found. 18 para-infectious myelitis occurred over a wide age range (Beh et al., 2013-67), mean age 50.7±18.6 years, with 10/18 (55.6%) women. Covid-19 involvement was variable from asymptomatic cases to severe Covid-19 resulting in death. The mean time to establish myelitis from the onset of Covid-19 symptoms was 10.3 ±7.8 days (0-24). The most common clinical form was transverse myelitis (14/18 patients, 77.7%) and the most frequent radiological form was longitudinally extensive myelitis (11/17 patients, 64.7%). In CSF mild lymphocytosis (14/16, 87.5%) with low cellularity (40.9±49.7/μL) and elevated proteins (11/16, 77.8%, mean 145.0 mg±159.0/dL) were frequent. Oligoclonal bands were usually negative (7/9, 77.7%) and mirror pattern was found in 2/7 patients (33.3%). SARS-CoV-2 PCR in CSF was negative in 10/10 cases. Conclusion: SARS-CoV-2 can cause myelitis by immune-mediated mechanisms. Clinical-radiological characteristics of Covid-19 para-infectious myelitis were variable and non-specific.

Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

“…The latency period (mean time between the onset of COVID-19 infection to first symptom of inflammatory myelopathy) of AIM varied from 2 days 22 to 3 wks. 31 , 33 Six patients 16 , 21 , 26 , 28 , 29 , 34 did not report any COVID-19 symptoms previously, presented directly with neurological symptoms (either urinary symptoms or sudden weakness).…”

“…On MRI of the spine, nine patients had demyelinating changes in the “cervical region only.” 18 , 26 – 28 , 30 – 32 , 35 , 36 Demyelinating change in “thoracic region only” was seen in nine patients. 11 – 13 , 17 , 19 – 21 , 25 , 33 Simultaneous and/or overlapping involvement of both regions, “cervical and thoracic,” were seen in 15 patients. 14 – 16 , 22 – 26 , 29 , 34 , 37 – 41 Based on the length of the longitudinal (demyelinating) lesions, it was categorized into two groups.…”

The Significance of COVID-19 Immunological Status in Severe Neurological Complications and Multiple Sclerosis—A Literature Review

“…For example, a Spanish group of researchers reported a patient with asymptomatic SARS-CoV-2 infection and hypoesthesia in the limbs and perineum. The radiographic image corresponded to acute transverse myelitis, and CSF tests showed bands corresponding to IgM anti-GD2 and GD3 antibodies [ 47 ]. A negative PCR result and the presence of antibodies or autoantibodies strongly suggest that the indirect mechanism of SARS-CoV-2 is via an attack on the nervous system.…”

“…Oligoclonal bands were usually negative. The CSF PCR test was negative in each analyzed case [ 47 ]. An interesting case was presented by a 60-year-old woman with transverse myelitis with positive IgM anti-GD2 and IgM anti-GD3 antibodies [ 47 ].…”

“…The CSF PCR test was negative in each analyzed case [ 47 ]. An interesting case was presented by a 60-year-old woman with transverse myelitis with positive IgM anti-GD2 and IgM anti-GD3 antibodies [ 47 ]. One case report suggests the possibility of a lupus anticoagulant in acute myelitis accompanying the COVID-19 infection.…”