Thomson Hospital Kota Damansara, 47810, Kuala Lumpur, Malaysia.
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400, Serdang, Selangor, Malaysia.
BMC Neurol. 2021 Oct 12;21(1):395. doi: 10.1186/s12883-021-02427-x.
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.
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.
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.
横贯性脊髓炎（TM）是一种相对少见的疾病，疫苗相关性脊髓炎则更为罕见。在 COVID-19 疫苗的安全性和疗效试验报告 TM 后，人们对疫苗接种后神经系统并发症的担忧加剧。
我们报告了首例在马来西亚接种黑猩猩腺病毒载体（ChAdOx1 nCoV-19）疫苗后发生的 Longitudinal Extensive Transverse Myelitis（LETM）。一名 25 岁女性，双侧下肢无力且无法行走，感觉平面至 T8，无视觉症状。紧急钆增强磁共振成像（MRI）显示胸段长节段 TM。脑脊液抗水通道蛋白-4 和抗髓鞘少突胶质细胞自身抗体阴性。诊断为疫苗接种后 LETM，患者开始接受大剂量静脉甲基强的松龙治疗。治疗后，患者最终康复。
LETM 是疫苗接种后的一种罕见但严重的不良反应。先前报道的病例显示症状在接种后 10-14 天之间出现，提示存在延迟的免疫反应。然而，COVID-19 相关的脊髓炎发病率要高得多，远远超过与疫苗接种相关的风险。
