Severe respiratory failure represents the most fatal aspect of COVID-19. However, other consequences of the disease including neurological deficits may result in long-term disability. We report a rare case of transverse myelitis (TM) in a child associated with SARS-CoV-2 infection.
A 3-year-old female with no significant past medical history presented to the emergency department with acute-onset weakness in all four extremities. Within hours, the patient experienced respiratory distress, worsening weakness, and decreased level of consciousness. She was intubated and admitted to the PICU. Within the next few days, she was found to be positive for the SARS-CoV-2 virus. The diagnostic workup included CSF with increased protein and WBCs, along with MRI demonstrating spinal cord edema and non-compressive myelopathy, consistent with TM. The patient was given IVIg and IV steroids with no noticeable change in neurologic deficits. Following several months of intensive rehabilitation with physical, occupational, and speech therapies, she had no significant improvement in her extremity weakness and remained ventilator-dependent.
TM is characterized by spinal cord inflammation, typically due to infectious or immune system disorders. This report describes a case of TM in a child resulting from COVID-19. We highlight the initial medical management and subsequent rehabilitation involved in her care. There are only a few known cases of TM resulting from the SARS-CoV-2 virus, most of which are in adults. In most cases, symptoms developed in the absence of respiratory symptoms, and were associated with a prolonged recovery despite aggressive immunomodulatory therapy.
Buton, Chris and Robert Allen. "Rehabilitation Considerations and Management in a Pediatric Patient with Acute Transverse Myelitis Associated with COVID-19." (2021). https://digitalrepository.unm.edu/hsc_2021_pediatric_research/13