Sex: M
Vaccine: COVID19
Symptoms: Anti-aquaporin-4 antibody, Antinuclear antibody, CSF test, Electrophoresis protein, Magnetic resonance imaging
Clinical narrative: TRANSVERSE MYELITIS; This spontaneous report was received from other health care professional via literature:  This report concerned a 66 year old male of an unspecified race and ethnic origin. The objective of the authors was to illustrate a clinical picture of Covid-19 vaccine-related transverse myelitis, a rare but serious complication of the vaccine. The prolonged course of this patient's complications was concerning, although the benefit of receiving the vaccine remains unquestionable. Furthermore, although the timing of symptom onset and vaccination suggests a relation, there were other diagnoses that could explain the presentation and further research was needed regarding vaccine-related side effects and to emphasize the importance of maintaining a high index of suspicion for neurological issues of unclear etiology following recent Covid-19 vaccination despite their rare occurrence. The patient's height, and weight were not reported. The patient's past medical history included: alcohol abuse, and ablation, and concurrent conditions included: wolff parkinson white syndrome (WPW status post ablation), stable thoracic aortic aneurysm, peripheral neuropathy (secondary to past alcohol abuse), osteoarthritis, GERD (Gastroesophageal Reflux Disease), anxiety, former smoker, and non-alcohol user, and other pre-existing medical conditions included: The patient denied drug use. The patient's Family history was remarkable for cancer, coronary artery disease, and diabetes in his father. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: UNKNOWN) dose, start therapy date were not reported, 1 in total administered for covid-19 prophylaxis. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included metoprolol, olanzapine, pantoprazole, tamsulosin and venlafaxine.  On an unspecified date, the patient was admitted to the hospital two weeks after the vaccination with progressive ambulatory dysfunction and lower extremity weakness which was two months prior from the time of reporting. At that time, he was diagnosed with transverse myelitis after MRI (Magnetic Resonance Imaging) showed a spinal cord lesion concerning for demyelination at T3-T4. The patient was treated with IV (Intravenous) steroids and discharged. Neurology impression at time of discharge was transverse myelitis possibly related to Covid vaccination two weeks prior to admission. The number of days of hospitalization was not reported. The patient stated he was doing fine after initial discharge before recurrence of his progressive weakness and difficulty walking that led to the current admission. On an unspecified date, the patient presented with similar complaints that began ten days ago from the time of reporting. He denied fever, chest pain, abdominal pain, and bladder/ bowel incontinence. Neurological exam was positive for atrophy and decreased vibratory sensation in bilateral lower extremities. His gait is not assessed due to safety concerns, but the patient noted he had begun using a cane to assist with ambulation. Otherwise, physical exam was unremarkable. Imaging studies include MRI showing T3-T4 hyperintensity, as seen during previous admission two months prior. Laboratory data (dates unspecified) included: ANA (Antinuclear Antibody) Negative, Anti-aquaporin-4 antibody (APQ-4) Negative, CSF (Cerebrospinal Fluid) test Negative, Rheumatoid factor Negative, and SPEP (serum protein electrophoresis) Negative. After an unrevealing workup, the patient experienced symptomatic improvement with IV steroids and was discharged home. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from transverse myelitis. The authors concluded that Diagnostic criteria for transverse myelitis included sensory, motor, or autonomic dysfunction attributable to spinal cord, no evidence of cord compression, bilateral symptoms with clear sensory level, and inflammation defined by CSF analysis, elevated IgG (ImmunoglobulinG), or MRI enhancement. Neurological complications of the Covid vaccine include general symptoms such as headache, fever, and fatigue, Bell's palsy, encephalomyelitis, myelitis, and cerebral venous sinus thrombosis. This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0:20221240523-Transverse myelitis. The case causality is considered CONSISTENT. Rationale: Considering no previous history that is suggestive of any infection, inflammatory condition, negative laboratory investigations and close temporal association with vaccination, hence considered consistent.