Abstract
Introduction
We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020.
Case presentation
We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4–C6 spinal epidural abscess (SEA) requiring a C3–C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1–T7 SEA. He underwent a T3–T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ).
Discussion
To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.
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Acknowledgements
We thank Adriana Cassinis and Raffaella Tosi for their insights and helpful discussions, and all the staff working in our Unipolar Spinal Unit for their help in managing patients and finding medical records.
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Sampogna, G., Tessitore, N., Bianconi, T. et al. Spinal cord dysfunction after COVID-19 infection. Spinal Cord Ser Cases 6, 92 (2020). https://doi.org/10.1038/s41394-020-00341-x
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DOI: https://doi.org/10.1038/s41394-020-00341-x
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