Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review

• Published in: Multiple sclerosis and related disorders Vol. 49; p. 102783
• Main Authors: Rodríguez de Antonio, Luis Alberto, González-Suárez, Inés, Fernández-Barriuso, Inés, Rabasa Pérez, María
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2021
• Subjects: Adult; COVID-19 - complications; Female; Humans; Immunoglobulin M; Myelitis - virology; Nervous System Diseases - virology; Neurology; Original; Pandemics
• ISSN: 2211-0348; 2211-0356; 2211-0356
• DOI: 10.1016/j.msard.2021.102783

•Para-infectious myelitis can occur as a result of Sars-Cov2 infection.•Transverse myeltis and longitudinally extensive myelitis cases were most frequently reported.•Covid-19 symptoms in myelitis cases varied from asymptomatic cases to severe Covid-19 resulting in death.•Particular findings of our case are that Covid-19 was asymptomatic and anti-GD2/GD3 IgM was found•The pathophysiology of this disease can be due to immuno-mediated mechanisms, possibly by autoantibodies. Even though SARS-CoV-2 is a predominantly respiratory virus, several reports have described various neurological disorders, from the beginning of the pandemic. The first para-infectious myelitis case was described in Wuhan in February 2020. Nevertheless, data from registries and reviews are scarce. A 40-year-old female with T5-T6 SARS-CoV-2 para-infectious myelitis is reported. A literature review of the published literature on the SARS-CoV-2 and para-infectious myelitis was done. Epidemiological, clinical, laboratory, image, treatment, and outcome data are described. Particular findings of our case are that Covid-19 was asymptomatic and anti-GD2/GD3 IgM was found. 18 para-infectious myelitis occurred over a wide age range (Beh et al., 2013-67), mean age 50.7±18.6 years, with 10/18 (55.6%) women. Covid-19 involvement was variable from asymptomatic cases to severe Covid-19 resulting in death. The mean time to establish myelitis from the onset of Covid-19 symptoms was 10.3 ±7.8 days (0-24). The most common clinical form was transverse myelitis (14/18 patients, 77.7%) and the most frequent radiological form was longitudinally extensive myelitis (11/17 patients, 64.7%). In CSF mild lymphocytosis (14/16, 87.5%) with low cellularity (40.9±49.7/μL) and elevated proteins (11/16, 77.8%, mean 145.0 mg±159.0/dL) were frequent. Oligoclonal bands were usually negative (7/9, 77.7%) and mirror pattern was found in 2/7 patients (33.3%). SARS-CoV-2 PCR in CSF was negative in 10/10 cases. SARS-CoV-2 can cause myelitis by immune-mediated mechanisms. Clinical-radiological characteristics of Covid-19 para-infectious myelitis were variable and non-specific.