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

Kang Zhao; Jucun Huang; Dan Dai; Yuwei Feng; Liming Liu; Shuke Nie

After admission, the laboratory test such as blood routine, C-reactive protein, serum amyloid protein, procalcitonin and large biochemistry were shown in Table 1 . On admission, CEA was normal, serum ferritin > 2000 (normal range 21.81-274.6ng/ml), electrolytes: no obvious abnormality except serum iron (see Table 1 ). Hypersensitive troponin was normal. Blood lipid showed low high-density lipoproteinemia, high density lipoprotein cholesterol (HDL-C) 0.51 (1. 16 Table 2 . Before treatment on February 15th, chest CT showed patchy high-density blurred shadow in the upper lobe of the left lung (figure 1A) and patchy ground glass shadow in the anterior segment of the upper lobe of the right lung (figure 1B), considering viral pneumonia. Cranial CT revealed bilateral basal ganglia and paraventricular lacunar infarction, brain atrophy (figure 2). CSF serological testing and MRI of spinal cord were not performed for pandemic during hospitalization. For positive 2019-nCoV test, COVID-19 was diagnosed. Based on the acute flaccid myelitis of lower limbs, urinary and bowel incontinence, and sensory level at T10, diagnosis of acute myelitis was more likely. After admission, oxygen inhalation treatment with high-flow nasal catheters was given. Meanwhile, the patient was treated with comprehensive drug therapies: ganciclovir( 0.5g once daily) for 14 days, lopinavir/ritonavir (500mg twice daily) for 5 days, moxifloxacin(400mg once daily) for 6 days, meropenem (1g twice daily) for 8 days, glutathione(1.8g once daily) for 14 12 days, dexamethasone (10mg once daily) for 10 days; human immunoglobulin (15g once daily) for 7 days, mecobalamin (1000ug once daily) for 14days; pantoprazole(80mg once daily) for 10 days. On the second day after admission, the patient's body temperature basically returned to normal, and the oxygen saturation was more than 93% at rest. There was no occurrence of adverse drug reactions and contraindications. The muscle strength of both upper limbs recovered to grade 4/5, and the muscle strength of both lower limbs was grade 1/5. Two times novel coronavirus RNA nasopharyngeal swabs tests were negative with an interval of more than one day. Re-examination of pulmonary CT showed that the lesions were absorbed and met the discharge criteria of COVID-19. Then, he was discharged and transferred to a designated hospital for isolation treatment and rehabilitation therapy.