Pearls & Oy-sters: Hemorrhagic Myelitis Following SARS-CoV-2 Infection

Hemorrhage in the setting of myelitis is rarely seen in clinical practice. We report a series of three women aged 26, 43, and 44 years-old, who presented with acute hemorrhagic myelitis within 4 weeks of SARS-CoV-2 infection. Two required intensive care and one had severe disease with multi-organ failure. Serial magnetic resonance imaging (MRI) of the spine demonstrated T2-weighted hyperintensity with T1-weighted post-contrast enhancement in the medulla and cervical spine (patient 1), and thoracic spine (patients 2 and 3). Hemorrhage was identified on pre-contrast T1-weighted, susceptibility weighted and gradient echo sequences. Distinct from typical inflammatory or demyelinating myelitis, clinical recovery was poor in all cases, with residual quadriplegia or paraplegia, despite immunosuppression. These cases highlight that although hemorrhagic myelitis is rare, it can occur as a post/para-infectious complication of SARS-CoV-2 infection.