Multisystem inflammatory syndrome in adult with longitudinally extensive transverse myelitis following SARS-CoV-2 vaccination: A case report

Abstract

Multisystem inflammatory syndrome in adults (MIS-A) is a known complication arising after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination. However, longitudinal extensive transverse myelitis (LETM), which is a neurological manifestation of MIS-A, is rarely reported among individuals after SARS-CoV-2 infection or vaccination. Here, we present a case of a 38-year-old female, with a history of SARS-CoV-2 infection in May 2021 and subsequent SARS-CoV-2 vaccination (on November 1, 2021; COVISHIELD™, ChAdOx1 nCoV-19 Corona Virus Vaccine), who presented with acute flaccid quadriparesis with bowel and bladder involvement since December 26, 2021. While being treated in the hospital, she developed fever, rash, shock, myocarditis, breathlessness, jaundice, and acute kidney injury. Magnetic resonance Imaging revealed LETM. She was negative for SARS-CoV-2 infection and showed raised in SARS-CoV-2 antibody titer. Thus, she was diagnosed as having MIS-A with LETM and managed with Intravenous Immunoglobulin, antibiotics, hemodialysis, and steroids with improvement.