Transverse myelitis following COVID-19: Insights from a multi-center study and systematic literature review.

Introduction: We aimed to provide insights into transverse myelitis (TM) following COVID-19 by analyzing cases treated at tertiary care neurology centers and a systemic review of the literature.
Methods: The retrospective observational multi-center study was conducted at the four university neurology departments in Croatia, Slovenia, Serbia, and Austria. We searched for acute myelitis cases that occurred during or after COVID-19. A systemic review of the literature on COVID-19 and transverse myelitis was performed.
Results: We identified 76 persons with TM associated with COVID-19, 13 from the multi-center study and 63 from the literature review. Most of the participants (55.6%) had an intermediate latency, 25.4% had short and 19% long latency from COVID-19 symptoms to TM. The clinical presentation consisted of the typical TM signs. More than half of the participants had inflammatory changes in the CSF, with rare patients having intrathecal OCB synthesis and positive serology for anti-MOG or anti-AQP4 antibodies. Persons with autonomic symptoms and CSF pleocytosis were significantly more common to have an intermediate latency of 8 to 21 days from COVID-19 to TM (p = 0.005 and p = 0.003; respectively). According to logistic regression analysis, only participants with lesions evident on spinal cord MRI compared to normal spinal cord MRI had reduced risks for poor recovery. >80% of participants were treated with a combination of corticosteroids and intravenous immunoglobulins or plasma exchange with 73% having incomplete recovery.
Conclusion: Our study further characterizes clinical, laboratory, and MRI features, as well as treatment of TM associated with COVID-19.
Competing Interests: Declaration of Competing Interest MH, IA, MKS: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva/Teva, Roche, Alvogen, Actelion, Alexion Pharmaceuticals, TG Pharmaceuticals. EB, BS: nothing to disclose. GBJ: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Sanofi Genzyme, Merck, Novartis, Pliva/Teva, Roche, Lek. JS: received honoraria for presentations and as member of scientific advisory boards from Alexion, Angelini, Biogen, BMS, Boehringer, Horizon Therapeutics, Immunic, Janssen, Merck, Novartis, Pfizer and Sanofi. JD: serves on scientific advisory boards for Bayer, Biogen, Medis, Merck, Novartis, Roche, Sanofi-Genzyme, Janssen and Teva and have received speaker bureaus for Biogen, Bayer, Merck, Roche, Sanofi-Genzyme, Janssen, Medis, Hemofarm, Medtronic, Zentiva, and Teva. OT: received speaker honoraria and travel grants from Hemofarm, Medis, Merck, Novartis, Roche and Sanofi-Genzyme. MB: received speaker honoraria and travel grants from Hemofarm, Medis, Merck, Novartis, Roche, Sanofi-Genzyme and Janssen. NV: received speaker honoraria and travel grants from Hemofarm, Medis, Merck, Novartis, Roche and Sanofi-Genzyme.AHL: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Sanofi Genzyme, Merck, Novartis, Pliva/Teva, Roche, Lek, Janssen. JJ: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Novartis. SG: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Novartis. LH: No conflicts of interest.
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