Cho Su-Yeon, Jang Bo-Hyun, Seo Jun-Won, Kim Suk-Whee, Lim Kyung-Joon, Lee Hyun-Young, Kim Dong-Joon
Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea.
Department of Internal Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea.
World J Clin Cases. 2023 Feb 26;11(6):1419-1425. doi: 10.12998/wjcc.v11.i6.1419.
Transverse myelitis (TM) is characterized by sudden lower extremity progressive weakness and sensory impairment, and most patients have a history of advanced viral infection symptoms. A variety of disorders can cause TM in association with viral or nonviral infection, vascular, neoplasia, collagen vascular, and iatrogenic, such as vaccination. Vaccination has become common through the global implementation against coronavirus disease 2019 (COVID-19) and reported complications like herpes zoster (HZ) activation has increased.
This is a 68-year-old woman who developed multiple pustules and scabs at the T6-T9 dermatome site 1 wk after vaccination with the COVID-19 vaccine (Oxford/AstraZeneca ([ChAdOx1S{recombinant}]). The patient had a paraplegia aggravation 3 wk after HZ symptoms started. Spinal magnetic resonance imaging (MRI) showed transverse myelitis at the T6-T9 Level. Treatment was acyclovir with steroids combined with physical therapy. Her neurological function was slowly restored by Day 17.
HZ developed after COVID-19 vaccination, which may lead to more severe complications. Therefore, HZ treatment itself should not be delayed. If neurological complications worsen after appropriate management, an immediate diagnostic procedure, such as magnetic resonance imaging and laboratory tests, will start and should treat the neurological complications.
横贯性脊髓炎（TM）的特征为下肢突然出现进行性无力和感觉障碍，且大多数患者有病毒感染前驱症状史。多种疾病可与病毒或非病毒感染、血管病变、肿瘤、胶原血管病及医源性因素（如疫苗接种）相关而导致TM。随着全球范围内针对2019冠状病毒病（COVID-19）疫苗接种的普及，报告的诸如带状疱疹（HZ）激活等并发症有所增加。
这是一名68岁女性，在接种COVID-19疫苗（牛津/阿斯利康[ChAdOx1S{重组}]）1周后，T6 - T9皮节部位出现多个脓疱和结痂。HZ症状出现3周后患者截瘫加重。脊髓磁共振成像（MRI）显示T6 - T9水平横贯性脊髓炎。治疗采用阿昔洛韦联合类固醇并辅以物理治疗。到第17天时其神经功能缓慢恢复。
COVID-19疫苗接种后发生HZ，可能导致更严重的并发症。因此，HZ治疗本身不应延迟。若经适当处理后神经并发症恶化，应立即启动磁共振成像和实验室检查等诊断程序，并对神经并发症进行治疗。
