Spinal cord dysfunction after COVID-19 infection

Sampogna, G.; Tessitore, Noemi; Bianconi, Tatiana; Leo, Alessandra; Zarbo, M.; Montanari, Emanuele; Spinelli, Michele

doi:10.1038/s41394-020-00341-x

Cited by 20 publications

(15 citation statements)

References 31 publications

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“…Severe infections following anti-IL-6-directed therapy have been reported in patients with RA (7,9,(11)(12)(13)(14), giant cell arteritis (GCA) (14), Takayasu arteritis (15), adult-onset Still's disease (16), and COVID-19 infection (17). However, they have not been reported in iMCD patients, except for a single case report in a patient on siltuximab (8).…”

Section: Discussionmentioning

confidence: 99%

Psoas and Mediastinal Abscesses during Intravenous Tocilizumab Treatment in Multicentric Castleman Disease

et al. 2023

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Tocilizumab has been used to treat idiopathic multicentric Castleman disease (iMCD). As tocilizumab prevents interleukin-6 from exerting pro-inflammatory effects, there is some concern about a delayed diagnosis of severe infections during tocilizumab treatment. Although serious infections during tocilizumab therapy have been previously described in patients with rheumatoid arthritis, they have not been reported in iMCD. We herein report a case of disseminated Staphylococcus aureus infection after a superficial skin wound followed by psoas and mediastinal abscesses with pyogenic spondylodiscitis in an iMCD patient with diabetes. Physicians should be alert for the occurrence of disseminated S. aureus infection after even minor skin injury during tocilizumab therapy.

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Section: Discussionmentioning

confidence: 99%

Psoas and Mediastinal Abscesses during Intravenous Tocilizumab Treatment in Multicentric Castleman Disease

et al. 2023

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“…Moreover, the levels of antibodies against SARS-CoV-2 decay rapidly after recovery, suggesting that SARS-CoV-2 infection may exert profound and long-lasting complications to adaptive immunity [ 10 ]. In literature, we found cases with neurological complications after COVID-19 illness, such as similar rapidly progressive paraparesis but MRI showed multifocal myelitis affecting the cervical cord [ 2 ], or spinal cord dysfunction in patients with three different changes on MRI; ischemia, spinal epidural abscess and infection of Staphylococcus aureus [ 11 ]. In this case of paraparesis MRI repeatedly remained normal, so analyzing the mechanism of disease we can assume the immune-mediated pathogenesis in response to the virus or its antibodies.…”

Section: Discussionmentioning

confidence: 99%

Spastic Paraparesis After SARS-CoV-2 Infection Without Radiological Changes

Zukić¹,

Topcic²,

Hodžić³

et al. 2022

Cureus

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Coronavirus disease 2019 (COVID-19) is primarily a disease of the respiratory system but severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause several immune-related complications including different neurological disorders, such as myelopathy with paraparesis. In this atypical case a female patient with progressive spastic paraparesis after COVID-19 infection, brisk reflexes and positive Babinski sign, reduced vibratory sensation to the thoracic level, elevated immunoglobulin levels (IgG) in cerebrospinal fluid, but negative magnetic resonance imaging (MRI) of the brain and spine, is presented.A 57-year-old woman with spastic paraparesis and inability to walk was admitted to our neurological department. About four months before hospitalization, she started feeling numbness and tingling in the feet and lumbar spine area. Gradually, numbness and tingling ascended to the thoracic spine level Th7/8, and she developed weakness mostly in her legs. In the neurological exam she had spastic paraparesis. MRI of the brain, cervical and thoracic spine did not reveal any signal abnormality. Serological testing for SARS-CoV-2 was performed and results were highly positive IgG and IgM+IgA levels. The lumbar puncture finding confirmed the suspicion of immune-related complications after SARS-CoV-2 infection (intrathecal IgG synthesis). This case draws attention to spastic paraparesis or progressive MRI-negative myelitis after SARS-CoV-2 infection, which obviously has immune-mediated pathogenesis that happen in response to the virus or its antibodies. Similarities in spastic paraparesis after human T-lymphotropic virus (HTLV-1) or human immunodeficiency virus (HIV-1) and SARS-CoV-2 infections were observed. The patient had a good response to corticosteroid therapy and had good recovery.

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“…Compared to our patient, she had a lower BMI (18.6 kg/m 2 ) and shorter disease duration (14 years), while as for comorbidities, cardiovascular disease was present, too [ 16 ]. A recent case report showed the occurrence of spinal cord abscesses with associated motor deficits in patients treated with tocilizumab for COVID-19 [ 17 ]. An epidural abscess with associated osteomyelitis of the spine has also been described in patients with RA treated with tocilizumab after a transient bacteriemia caused by Salmonella enteritidis [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Psoas abscess during treatment with intravenous tocilizumab in a patient with rheumatoid arthritis: a case-based review

Vajdić

Štimac²,

Pezelj³

et al. 2021

Rheumatol Int

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Interleukin-6 receptor antagonist tocilizumab is a biologic drug used for treating patients with active rheumatoid arthritis (RA) who failed to respond to synthetic or other biologic disease-modifying antirheumatic drugs or where they were contraindicated. Interleukin-6 receptor blockade results in a decrease of disease activity but has some potential adverse effects, the most common being infections. We present a case of a 75-year-old female patient with long-lasting RA, several comorbidities and multiple prior therapies, who developed back pain and general malaise during tocilizumab intravenous treatment. The laboratory findings were typical of toxemia, and the imaging findings revealed large psoas muscle abscess. Surgical and antibiotic treatment was performed with a good outcome. To our knowledge, this has been the first case of a psoas abscess in a patient with RA treated with tocilizumab described in the literature so far. We also present a review of the literature regarding infection, and particularly abscess formation in patients treated with biological disease-modifying antirheumatic drugs, tocilizumab included.

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Spinal cord dysfunction after COVID-19 infection

Cited by 20 publications

References 31 publications

Psoas and Mediastinal Abscesses during Intravenous Tocilizumab Treatment in Multicentric Castleman Disease

Psoas and Mediastinal Abscesses during Intravenous Tocilizumab Treatment in Multicentric Castleman Disease

Spastic Paraparesis After SARS-CoV-2 Infection Without Radiological Changes

Psoas abscess during treatment with intravenous tocilizumab in a patient with rheumatoid arthritis: a case-based review

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