Division of Neurology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Medicine (Baltimore). 2021 Dec 23;100(51):e28423. doi: 10.1097/MD.0000000000028423.
Transverse myelitis is an infectious or noninfectious inflammatory spinal cord syndrome. We report a rare case of transverse myelitis following vaccination against COVID-19.
A 70-year-old male presented with progressive sensorimotor dysfunction of the bilateral lower limbs 7 days after receiving the mRNA-1273 vaccine against COVID-19. Spinal magnetic resonance imaging revealed intramedullary lesions with gadolinium enhancement on the Th1/2 and Th5/6 vertebral levels. Cerebrospinal fluid (CSF) testing showed a mildly increased level of total protein and positive oligoclonal bands (OCB).
The patient was diagnosed with acute transverse myelitis.
The patient received 5 days of intravenous methylprednisolone pulse (1000 mg/day) followed by oral prednisolone (30 mg/day with gradual tapering).
The patient fully recovered from muscle weakness of the lower limbs. He was discharged from our hospital and able to independently walk without unsteadiness.
This is a rare case of transverse myelitis following COVID-19 vaccination. Positive OCB in CSF in the present case highlights the possibility of autoimmune processes, including polyclonal activation of B lymphocytes, following vaccination.
横贯性脊髓炎是一种感染性或非感染性的脊髓炎症综合征。我们报告了一例接种 COVID-19 疫苗后发生横贯性脊髓炎的罕见病例。
一名 70 岁男性，在接种 mRNA-1273 疫苗预防 COVID-19 后 7 天出现双侧下肢进行性感觉运动功能障碍。脊髓磁共振成像显示 Th1/2 和 Th5/6 椎体水平的髓内病变，钆增强。脑脊液（CSF）检测显示总蛋白水平轻度升高，寡克隆带（OCB）阳性。
患者被诊断为急性横贯性脊髓炎。
患者接受了 5 天的静脉注射甲基强的松龙脉冲（1000mg/天），随后口服泼尼松（30mg/天，逐渐减量）。
患者下肢肌无力完全恢复。他从我院出院，能够独立行走，步态稳定。
这是一例接种 COVID-19 疫苗后发生的横贯性脊髓炎的罕见病例。本病例 CSF 中的阳性 OCB 提示接种疫苗后可能存在自身免疫过程，包括 B 淋巴细胞的多克隆激活。
