Sampogna Gianluca, Tessitore Noemi, Bianconi Tatiana, Leo Alessandra, Zarbo Michele, Montanari Emanuele, Spinelli Michele
Unipolar Spinal Unit and Neurourology Service, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Spinal Cord Ser Cases. 2020 Sep 30;6(1):92. doi: 10.1038/s41394-020-00341-x.
We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020.
We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ).
To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.
我们观察到2019冠状病毒病（COVID-19）后出现脊髓功能障碍（SCD）的个体。我们报告的目的是介绍2020年2月21日至7月15日期间，在意大利北部一家转诊中心，我们对COVID-19后出现SCD个体的初步经验。
我们报告了3例COVID-19后出现SCD的男性患者。病例1，69岁，在COVID-19症状出现27天后，因T8至脊髓圆锥的脊髓缺血，醒来时出现T10美国脊髓损伤协会（AIS）B级截瘫，此外还有弥漫性血栓形成。病例2，56岁，在COVID-19发病29天后报告进行性颈痛，并伴有C3 AIS C级四肢瘫。磁共振成像（MRI）显示C4-C6脊髓硬膜外脓肿（SEA），需要进行C3-C4左侧半椎板切除术。病例3，48岁，在被诊断为COVID-19后第16天报告背痛并伴有下肢肌肉无力。检查发现T2 AIS A级截瘫，MRI显示T1-T7 SEA。他接受了T3-T4椎板切除术。在出现SCD之前，所有3例患者均因COVID-19出现呼吸衰竭，需要机械通气，有心血管危险因素，出现淋巴细胞减少，并接受了托珠单抗（TCZ）治疗。
据我们所知，这是COVID-19后SCD的首例报告。根据我们的经验，我们未观察到直接病毒感染，但存在两种不同病因。在病例1中，患者发生了脊髓缺血，而在病例2和病例3中，SEA可能与用于治疗COVID-19的TCZ的使用有关。
