Systematic Review of Cases of Acute Myelitis in Individuals with COVID‐19

Schulte, Eva C.; Hauer, Larissa; Kunz, Alexander B.; Sellner, Johann

BACKGROUND: An incremental number of cases of acute transverse myelitis (ATM) in individuals with ongoing or recent coronavirus disease 2019 (COVID‐19) have been reported. METHODS: We performed a systematic review of cases of ATM described in the context of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection by screening both articles published and in preprint. RESULTS: Twenty cases were identified. There was a slight male predominance (60.0%) and the median age was 56 years. Neurological symptoms first manifested after a mean of 10.3 days from the first onset of classical, mostly respiratory symptoms of COVID‐19. Overall, COVID‐19 severity was relatively mild. PCR of CSF for SARS‐CoV‐2 was negative in all 14 cases examined. Cerebrospinal fluid findings reflected an inflammatory process in most instances (77.8%). Aquaporin‐4 and myelin oligodendrocyte protein (tested in 10 and 9 cases, respectively) antibodies in serum were negative. On MRI, the spinal cord lesions spanned a mean of 9.8 vertebral segments, necrotic‐hemorrhagic transformation was present in three cases and two individuals had additional acute motor axonal neuropathy. More than half of the patients received a second immunotherapy regimen. Over a limited follow‐up period of several weeks, 90% of individuals recovered either partially or near fully. CONCLUSION: Although causality cannot readily be inferred, it is possible that cases of ATM occur para‐ or post‐infectiously in COVID‐19. All identified reports are anecdotal and case descriptions are heterogenous. Whether the condition and the observed radiological characteristics are specific to SARS‐CoV‐2 infection needs to be clarified.