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Acute Necrotizing Myelitis Associated with COVID-19

 Ji Eun Yoo  ;  Hui Jin Shin  ;  Hoon-Chul Kang  ;  Joon Soo Lee  ;  Heung Dong Kim  ;  Ha Neul Lee 
 YONSEI MEDICAL JOURNAL, Vol.64(11) : 692-695, 2023-11 
Journal Title
Issue Date
COVID-19 Vaccines ; COVID-19* / complications ; Child ; Female ; Humans ; Methylprednisolone / therapeutic use ; Myelitis, Transverse* / diagnosis ; Myelitis, Transverse* / drug therapy ; Myelitis, Transverse* / etiology
Acute necrotizing myelitis ; COVID-19 ; autoimmune ; transverse myelitis
Acute ascending hemorrhagic longitudinally extensive transverse myelitis is a rare inflammatory demyelinating disorder, which invades several vertebral segments and progresses rapidly and manifests severe symptoms. We present a case of acute necrotiz ing myelitis associated with COVID-19 infection. A 10-year-old female, with no previous medical history and no prior administra tion of COVID-19 vaccination, contracted COVID-19 in early April 2022. Two weeks later, she suffered from severe posterior neck pain and also presented with motor weakness and numbness in both lower extremities, making it difficult to walk independently and spontaneously void urine. Initial spinal cord MR showed longitudinally segmental extensive T2 hyperintensities. Cerebrospi nal fluid (CSF) analysis revealed elevated red blood cell, normal white blood cell, and elevated protein levels and absence of oli goclonal bands. CSF culture and viral polymerase chain reaction were negative. Autoimmune work-up was negative. She was started on intravenous methylprednisolone 1g/day for 5 days and immunoglobulin (Ig) 2 g/kg for 5 days. She was also treated with six courses of therapeutic plasma exchange. Nevertheless, her pain and motor weakness persisted. She eventually developed respiratory failure. Follow-up MR presented a newly noted small hemorrhagic component. She was consequently treated with two additional courses of methylprednisolone and Ig. At 6-months follow-up, neurological examination showed improvement with normal sensory function and motor grade IV function in both upper extremities. We present the case of acute necrotizing myelitis associated with COVID-19 infection. Multiple courses of methylprednisolone and Ig showed mild improvement in motor and sensory function. However, poor prognosis was unavoidable due to rapid progression of the disease.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Hoon Chul(강훈철) ORCID logo https://orcid.org/0000-0002-3659-8847
Kim, Heung Dong(김흥동) ORCID logo https://orcid.org/0000-0002-8031-7336
Shin, Hui Jin(신희진) ORCID logo https://orcid.org/0000-0002-1541-2564
Yoo, Ji Eun(유지은)
Lee, Joon Soo(이준수) ORCID logo https://orcid.org/0000-0001-9036-9343
Lee, Ha Neul(이하늘)
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