Transverse myelitis after Johnson & Johnson COVID-19 vaccine: illustrative case

Abstract

BACKGROUND Transverse myelitis is a rare neurological occurrence with varied presentation. Imaging is necessary to properly diagnose this condition; however, identifying the cause of this condition may often be difficult. OBSERVATIONS An otherwise healthy patient presented to the clinic with peculiar neurological symptoms without an obvious underlying cause. Imaging evidenced no significant structural defects but did lead to discovery of cord enhancement compatible with a diagnosis of transverse myelitis. Corticosteroid treatment was initiated rapidly to address this pathology, and the patient recovered without deficits. To identify the underlying cause, patient medical history was reviewed thoroughly and compared with existing literature. Previous tuberculosis infection could be a less likely cause of the neurological symptoms. However, recent vaccination with the Johnson & Johnson coronavirus disease 2019 (COVID-19) vaccine could be a more likely cause of the transverse myelitis, which has been rarely reported. LESSONS Transverse myelitis after COVID-19 infection has been an escalating phenomenon. However, transverse myelitis after COVID-19 vaccination is a rare occurrence that is also on the rise. Given the increased rates of vaccination, transverse myelitis should not be overlooked as a potential pathology, due to the severity of neurological impairment if this condition is not treated rapidly.

Treatment refractory acute necrotizing myelitis after COVID-19 vaccine injection: a case report

“…Immune-complex type reactions, neural-tissue molecular surface antigen adhesion-transportation pathways, virus re-activation after live-attenuated vaccine injection, virus neurotropism, cytokine-associated responses, and molecular mimicry are the most discussed molecular pathogenesis associated with post-vaccination/infectious myelitis 4 , 6 , 15 . Post infectious processes, inflammatory storm, abnormal interleukin and cytokine levels in the circulation and aquaporin disturbance can lead to cord oedema and myelitis 16 , 17 . Besides that, vector glycoprotein antigen or its chimpanzee adenovirus adjuvant have been tagged with possible immune system triggering cascades 18 .…”

Clinical and immune-related manifestations in patients with COVID-19

“…Corticosteroid treatment was started immediately and had a good effect. Symptoms improve gradually, with the numbness disappearing completely in about 6 weeks [24].…”

“…A few cases of myelitis have been reported, again mostly in men, with two age peaks (around 30 years and around 60-70 years). Other immune-related neurological manifestations are neuropathies, optic neuritis, opticomyelitis, trans-verse myelitis, plexopathy, or myasthenia gravis [2,17,18,19,20,21,22,23,24,25,26].…”

“…Transverse myelitis is a rare immune-mediated, focal disease of the spinal cord that can lead to severe neurologic complications, including autonomic, sensory, and motor deficits [24,25,26]. Imaging studies are necessary for the correct diagnosis of this condition, however, etiological identification can often be difficult.…”

“…Cases of transverse myelitis have also been reported following vaccination with AstraZeneca, Pfizer-BioNTech and Moderna-BioNTech. However, it is important to know that transverse myelitis is not limited to a post-vaccination complication, due to the many cases of the disease following infection with COVID-19 [24,25,26].…”