Acute longitudinal extensive transverse myelitis secondary t
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Novel SARS-CoV-2 has rapidly spread on a global scale since emerging from Wuhan City, Hubei Province, China at the end of 2019. Landmark features include fever, cough, dyspnoea, and altered sense of smell or taste. There is growing evidence demonstrating uncommon, but significant, neurological manifestations. This case report details one of the first cases of acute longitudinal extensive transverse myelitis (LETM) secondary to COVID-19 in the UK.

A 35-year-old woman, 6?months post partum, presented with acute onset back pain at the T8 level progressing to bilateral lower limb weakness and sensory loss with urinary retention and constipation. This patient had a pre-existing inflammatory disease, having recently developed ulcerative colitis antenatally. Five days prior to admission, she had tested positive asymptomatically on a SARS-CoV-2 reverse-transcriptase PCR nasopharyngeal swab.

The positive swab result was confirmed on admission. Clinical examination revealed bilaterally exaggerated knee reflexes, lower limb weakness and positive Babinski’s sign. Sensation was impaired at L4 and L5 dermatomes and absent at S1 and S2. MRI findings suggested longitudinal extensive transverse myelitis, with multiple regions of patchy hyperintensity seen in the thoracic region of the spinal cord both centrally and peripherally. She was started on a course of intravenous corticosteroids and improvement was seen both clinically and on repeat imaging.

This case demonstrates a rare complication to an asymptomatic COVID-19 infection and explores the potential neurotropic properties of COVID-19.