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Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0–52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren’s syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0–3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08–0.41) and 0.73/100,000 (incidence 0.02–0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region.

Background: Acute transverse myelitis (ATM) is a rare neurological complication of viral infections and vaccinations. We report a 72-year-old man with SARS-CoV-2-associated cervicothoracic ATM in Panama, and analyze the results of a bibliographic investigation on myelitis during COVID-19. Methods: Systematic review of 38 patients with COVID-19-associated myelitis from 19 countries published between March and October 2020. Findings: All patients had typical features of ATM with acute onset of paralysis, sensory level, and sphincter deficits due to spinal cord lesions demonstrated by imaging. There were 21 men (55%) and 17 women (age range, 21-73 years; mean age, 49 years) with two age peaks at 29 and 58 years, excluding two pediatric cases. Longitudinally-extensive ATM involved cervicothoracic segments in 14 cases (42%), localized ATM lesions affected cervical (10 cases) and thoracic cord segments (7 cases). Acute disseminated encephalomyelitis (ADEM) occurred in 7 patients, mainly women (67%) with ages ranging from 27 to 64 years. Two patients had blindness due to myeloneuritis optica, and 2 had acute motor axonal neuropathy. Interpretation: Acute myelitis is an unexpectedly frequent neurological complication of COVID-19. Short latency from onset of infection to first neurological symptoms may indicate a direct neurotropic effect of SARS-CoV-2 during the initial infection, while longer latency of the post-infectious neurological complications may be mediated by the host’s response to the virus. The immune mechanisms causing ATM remain unknown. It is conceivable that common antigens inducing ATM may occur in both SARS-CoV-2 and in the ChAdOx1 nCoV-19 Chimpanzee adenovirus vaccine. (ClinicalTrials.gov Identifier: NCT04324606). Funding: None. Declaration of Interests: The authors declare no competing interests.