一名健康成年女性患者的横贯性脊髓炎:一种罕见的病毒病因

Transverse Myelitis in a Healthy Adult Female Patient: A Rare Viral Etiology.

作者信息

Namrouti Amina, DesRosiers Mary, Barreto Claudette, Brandon Ian, Hodges Tate B, Mahmood Tariq

机构信息

Herbert Wertheim College of Medicine, Florida International University, Miami, USA.

Family Medicine, Baptist Health South Florida, Miami, USA.

出版信息

Cureus. 2024 Nov 18;16(11):e73932. doi: 10.7759/cureus.73932. eCollection 2024 Nov.

Abstract

Transverse myelitis (TM) is an uncommon but extensively documented neurological disorder marked by acute spinal cord inflammation, resulting in a spectrum of impairments including motor, sensory, and autonomic disturbances. We outline a rare case of viral-induced TM linked to COVID-19 and Coxsackie B viral infections. A 25-year-old healthy female patient presented with acute bilateral upper and lower extremity weakness, paresthesia, and urinary retention. MRI of the cervical spine revealed abnormal marrow signal intensity. Laboratory investigation highlighted the presence of SARS-CoV-2 RNA; Coxsackie B virus subtypes 1, 2, 4, 5, and 6; and positive Lyme disease IgG subtype. Lumbar puncture and systemic autoimmune cases of myelopathy were unrevealing. Treatment included high-dose steroids, plasmapheresis, Foley catheter placement, and continual physical therapy. Despite improvements, the patient did not reach baseline and was discharged for outpatient physical/occupational rehabilitation. To our knowledge, this is the only case that describes viral-induced TM associated with COVID-19, Coxsackie B, and Lyme disease simultaneously. The rarity of this case highlights the necessity for further investigation into the pathogenesis of viral-induced TM and whether viral causes contribute synergistically or independently to the onset of TM.

摘要

横贯性脊髓炎(TM)是一种罕见但有大量文献记载的神经系统疾病,其特征为急性脊髓炎症,可导致一系列功能障碍,包括运动、感觉和自主神经功能紊乱。我们概述了一例与新型冠状病毒肺炎(COVID-19)和柯萨奇B病毒感染相关的病毒诱导型TM罕见病例。一名25岁健康女性患者出现急性双侧上下肢无力、感觉异常和尿潴留。颈椎MRI显示骨髓信号强度异常。实验室检查发现存在严重急性呼吸综合征冠状病毒2(SARS-CoV-2)RNA;柯萨奇B病毒1、2、4、5和6型;以及莱姆病免疫球蛋白G(IgG)亚型阳性。腰椎穿刺和系统性自身免疫性脊髓病病例检查均无异常发现。治疗包括大剂量类固醇、血浆置换、放置 Foley 导管和持续物理治疗。尽管有所改善,但患者未恢复到基线水平,出院后接受门诊物理/职业康复治疗。据我们所知,这是唯一一例同时描述与COVID-19、柯萨奇B病毒和莱姆病相关的病毒诱导型TM的病例。该病例的罕见性凸显了进一步研究病毒诱导型TM发病机制以及病毒病因是否协同或独立导致TM发病的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53de/11655085/e9d414b79e15/cureus-0016-00000073932-i01.jpg

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