Transverse Myelitis After Johnson & Johnson COVID Vaccine - A Case Report

Introduction: As the novel coronavirus disease of 2019 (COVID) is an ongoing public health issue, many turn to vaccinations as a means of defense. While vaccination is generally safe, reports of rare pathologies subsequent to COVID vaccination exist, especially in the realm of neurological disorders. One such rare complication is tranverse myelitis, which will be the subject of this case report. Patients impacted by transverse myelitis may present with a varied neurological symptom, which may sometimes progress rapidly without treatment. These can include motor, sensory, and/or autonomic dysfunctions stemming from the spinal cord. These dysfunctions typically occur bilaterally at clearly defined sensory levels, and T2 weighted MRI will indicate cord hyperintensity. Case Description: A 56-year-old male patient presented to clinic with a chief complaint of episodic bilateral arm numbness. The patient tested positive for COVID in December of 2020, although recovery was uneventful. In May of 2021, the patient received the Johnson & Johnson COVID vaccine. The symptoms associated with his chief complaint developed approximately two months after receiving the vaccine. Two weeks preceding the patient visit, cervical Magnetic Resonance Imaging (MRI) was performed. Imaging evidenced severe cord edema from C1 to T1-2 with associated cord expansion. At C4-C5, there is a right sided disc protrusion causing moderate spinal stenosis with cord effacement. Additionally, the thecal sac measures 7mm at this level. At the C5-C6 and C6-C7 levels, there is evidence of moderate foraminal stenosis, bilaterally. Radiological evaluation confirmed these findings, while listing possible differentials of transverse myelitis, neuromyelitis optica, or a viral myelitis. Along with recommendation for follow up and referral for contrast MRI, oral corticosteroid treatment was rapidly initiated. One week after treatment, another cervical MRI was performed. The radiology interpretation noted decreased extent of the abnormal enhancing signal within the cervical cord, compatible with resolving transverse myelitis. Over the time course of multiple weeks, symptoms improved. Discussion: While the majority of cases may yield abnormal strength and DTR, transverse myelitis presentations after COVID vaccination may ultimately vary widely, necessitating thorough evaluation. The prognosis of transverse myelitis is rather varied and depends on factors such as rate of symptom progression, quality of nerve conduction, possibility of spinal shock, and speed of treatment initiation. Prompt treatment and management of symptoms may allow for a successful recovery, as in this patient's case.