Acute transverse myelitis (ATM) is an inflammatory disorder, caused by many etiologies, whether post infectious or autoimmune. Rarely, TM cases have been reported after both COVID-19 infection and COVID-19 vaccination. We describe our experience with TM after COVID-19 infection and conduct a literature review.

We report a case of ATM after COVID-19 infection and present a comprehensive literature review of TM cases reported after COVID-19 infection and COVID-19 vaccination. The literature search was done using PubMed and Google scholar and selected peer-reviewed articles. The search included all cases from Jan 2020 to Sept 2022. 

A total of 60 TM cases reported association with post-COVID-19 infection and 23 TM cases reported association with post-COVID-19 vaccinations. Among post-COVID-19 TM cases, the mean age was 49 years, and the youngest reported is 7month-old. 55% (33) of them are longitudinally extensive TM (LETM). The most common symptom is lower extremity weakness. 1 case was reported as necrotizing myelitis on biopsy, and another case was overlap syndrome of GBS with longitudinal TM. No cases reported the use of convalescent plasma therapy after infection. Almost all TM cases were treated with steroids, but some cases needed additional treatment since not all responded adequately. 6 cases (10%) responded with steroids + plasmapheresis, 5 cases (8%) responded with steroids + IVIG especially in the pediatric age group. One case reported a positive response after treatment with eculizumab, and another with infliximab. 2 cases (3%) remained paraparetic. 

Among post-covid-19 vaccine TM cases, 4 cases (17%) were reported LETM. 5 cases (21%) had symptom onset within a week after vaccination. Almost all of them reported responding with steroids except one case reported fatal after 58th day after vaccination. 

TM, post-COVID-19 infection, has been described in multiple cases, as well as being a rare complication of COVID-19 vaccination.