key: cord-0740583-05t611au
authors: Baghbanian, Seyed Mohammad; Namazi, Farzaneh
title: Post COVID-19 longitudinally extensive transverse myelitis (LETM)–a case report
date: 2020-09-18
journal: Acta Neurol Belg
DOI: 10.1007/s13760-020-01497-x
sha: 69a67359f42fa51d6ab54fa2e783cddd51f5e5c9
doc_id: 740583
cord_uid: 05t611au

nan

Brain MRI was normal and spinal cord MRI showed a longitudinally extensive transverse myelitis in the T8-T10 cord segments (Fig. 2) . Without corticosteroid therapy, plasmapheresis was done and paresis recovered to a certain degree. The patient was discharged and referred for rehabilitation treatment.

Central nervous system involvement in COVID disease occurs hematogenously or by neuronal retrograde or antegrade polarization via peripheral nerves, nucleus solitaries of the brain stem, spinal cord, olfactory and trigeminal system [1] .

Post-infection myelitis was reported in a confirmed COVID patient with high fever, bone marrow suppression, and liver function failure. It is interpreted that immune damage in the early stage of COVID might be explained the myelitis [2] .

In our patient after 14 days of the initial phase of COVID infection, myelitis presented without any signs of acute infection. No significant abnormality was seen in laboratory tests. Liver function tests, Anti NMO Ab, Anti MOG Ab, and CSF PCR for cytomegalovirus and herpes simplex virus were negative. CSF PCR for the COVID-19 virus was negative. Acute disseminated encephalomyelitis (ADEM) which presents after a systemic infection may present with LETM but ADEM without brain involvement is unusual.

IL-6 plays a key role in the second attack of COVID disease which begins 7-14 days after the first respiratory presentation. Although increase IL-6 induces B-cells differentiation and has an anti-inflammatory effect, it could cause acute phase cytokine overproduction and cytokine release syndrome (cytokine storm) associated with fever and multiple organ failure [3] . Guillain-Barré Syndrome associated with COVID infection was defined [4] . An autoimmune antibody reacting to myelin glycoproteins of peripheral nerves has been proposed as a mechanism of Guillain-Barré Syndrome(GBS) [5] . GBS associated with COVID infection raises consideration of COVID triggering possible autoimmunity and similarly induced autoimmunity which might Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 

Neurotropism of SARS-CoV 2: Mechanisms and manifestations

Acute myelitis after SARS-CoV-2 infection: a case report

Advances in the research of cytokine storm mechanism induced by Corona Virus Disease 2019 and the corresponding immunotherapies. Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi =

Guillain-Barré syndrome associated with SARS-CoV-2

Guillain-Barré syndrome