Sudden Onset of Myelitis after COVID-19 Vaccination: An Under-Recognized Severe Rare Adverse Event

Abstract

Myelitis has been reported as a complication of COVID-19 infection. However, it has rarely been reported as a complication of COVID-19 vaccination, and this may be the first case report following an mRNA vaccine. A 63 yo, otherwise healthy male, received his second dose of the Moderna vaccine on 08 April 2021. He had some initial pain and soreness at the injection site. Seventeen hours post dose, he reported pain and numbness in both calves which progressed to lower back pain, paresthesia in both feet, and pain in lower extremities. Over the day post- vaccination the patient’s condition worsened and he was unable to walk and unable to urinate voluntarily. On the second day post- vaccination he presented to the Emergency Department and was admitted to the University of Iowa hospital unable to walk with severe pain in lower back, legs and feet, and numbness in buttocks. Laboratory findings were unremarkable and lumbar puncture was not diagnostic. MRI revealed increased T2 cord signal seen in the distal spinal cord and conus. Initial treatment included IV Immunoglobulin for 2 days, followed by methylprednisolone 1000 mg/day IV for 5 days. Discharge from the hospital occurred on 16 April 2021 to inpatient rehabilitation. Treatment consisted of oral prednisone 60 mg/day with a tapering schedule. The patient slowly improved and was able to ambulate unassisted at 25 days post -vaccination. This case represents one of the first cases of myelitis reported in the literature after COVID-19 mRNA vaccination. As of 27 April 2021 the FDA VAERS system has 45 reports of transverse myelitis after COVID-19 vaccination (21 after Moderna vaccine, 19 were after Pfizer vaccine, and 5 occurred after Janssen vaccine).

Note:
Funding Statement: The author has not received any funding from any intramural or extramural source.

Declaration of Interests: The author declares no competing interests.

Patient Consent Statement: Consent for publication - Informed consent obtained.

Keywords: COVID-19 vaccine, myelitis, transverse myelitis, serious adverse event