Paediatric transverse myelitis during COVID-19 asymptomatic infection: A case report

Paediatric Transverse myelitis (TM) is a rare, demyelinating immune-mediated disorder of the Central Nervous System. Its immunopathogenesis is not completely understood. Viral infections are recognized triggers that precede TM in 66% of cases. Although uncommon, neurological involvement with spinal cord damage can occur following SARS-CoV-2 infection. Although the co-occurrence of TM and SARS-CoV-2 is more frequently observed in adults, children may also be affected. We report a pediatric case of TM during SARS-CoV-2 asymptomatic infection. A 12-year-old boy complained of severe nuchal pain that lasted for a few hours and was followed by hyposthenia on the right hemisoma persisting for approximately 12 h. Brain MRI scan was normal. Spinal cord MRI demonstrated a T2/FLAIR hyperintense lesion, enhancing post-contrast, at C2 level. CSF and blood microbiology and virology were negative. CSF SARS-CoV-2 genoma sequencing and oligoclonal bands were negative. Serology for AQP4 and anti-MOG antibodies was negative. Acyclovir, azithromycin and high dose intravenous methylprednisone were also administered for 8 days. The patient completely recovered and was discharged after 11 days with steroid tapering. He had a follow-up spinal cord MRI a month later that returned normal. Neurological complications during SARS-CoV-2 infection are rare in children, but may occur as a consequence of dysimmunity possibly triggered by SARS-CoV-2.