Transverse Myelitis Successfully Treated with Posterior Decompression Followed by Secretome and Mesenchymal Stem Cell Therapy.

Introduction: Transverse myelitis (TM) is a rare spinal cord disorder caused by inflammation. Usually, this occurs as a complication of infection or autoimmune disease; however, idiopathic causes such as vaccinations have been reported. There have been no studies that include the use of stem cells for TM in an inpatient setting. We present a case demonstrating the efficacy of stem cell therapy in the treatment of TM.

Case presentation: A 5-month-old boy developed TM (he abruptly developed paraplegia, paraesthesia of both legs, urinary retention) 7 days after he received the pneumococcal conjugate vaccine (PCV). Laboratory tests were all negative except for evidence of recent PCV vaccination. A paediatric neurologist confirmed the diagnosis when the boy was 2.5 years old. Magnetic resonance imaging of thoracic spine showed hyperintense central and dorsal cord abnormalities beginning at the T2 level and extending into the thoracic cord at T6. The pattern was consistent with TM. Decompression laminectomy was performed. The patient was then given mesenchymal stem cell (MSC)-derived secretome and umbilical cord mesenchymal stem cell (UCMSC) administered intrathecally (3× within interval 4 weeks). After the first, treatment he began to show significant improvement in terms of motor function and the patient also showed increasing in autonomic function especially in erectile function. After the 2^nd treatment there was adequate muscle response of the lower limbs, and his medical rehabilitation specialist trained him to do standing exercises. After the 3^rd treatment there was adequate muscle response of the lower limbs, and his medical rehabilitation specialist trained him to walk.To the best of our knowledge this is the first reported case of TM treated with stem cells in Indonesia. The pathophysiology of TM is an inflammatory disorder of the spinal cord that damages the myelin sheath of nerve fibres. Two primary therapies for TM are glucocorticoids and plasma exchange. Further, treatment options such as with secretome and UCMSCs promote both microenvironment correction and myelin regeneration.To the best of our knowledge our case is the first reported case of TM in Indonesia treated with stem cells.

Conclusion: Our case demonstrates the potential of stem cell therapy as an alternative treatment modality in a case there was no other optional therapy for longitudinal extensive TM.

Learning points: Alternative therapy with mesenchymal cell-derived secretome and umbilical cord mesenchymal stem cells is very effective for longitudinally extensive transverse myelitis.