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case_report·neurology, infectious disease, critical care, internal medicine, emergency medicine·PMC10328563

Hematomyelia associated with coronavirus disease 2019: A rare case report

Medicine · 4 authors, 3 centres

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TL;DR

The patient's symptoms improved after 4 weeks of anti-infective and immunomodulatory therapy, with MRI showing resolution of the spinal cord hematoma.

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Thoracolumbar MRI revealed a subdural hematoma and spinal cord edema, and CSF tested positive for COVID-19 nucleic acid. The patient received supportive treatments including anti-infection and immunomodulatory therapy. After 4 weeks, the patient's symptoms significantly improved, and follow-up MRI showed absorption of the spinal cord hematoma. The case demonstrates a possible therapeutic response but is limited by being a single observation, and the authors call for larger studies and animal models for confirmation.

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case_report

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neurology

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ORIGINAL PAPER

PMC10328563

Hematomyelia associated with coronavirus disease 2019: A rare case report

Medicine

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ABSTRACT

Rationale: Coronavirus disease 2019 (COVID-19) can damage the central nervous system. Although there have been reports of cerebral hemorrhage and infarction caused by COVID-19, hematomyelia due to COVID-19 has never been reported. Patient concerns: A 40-year-old male was admitted to the hospital with positive nucleic acid detection for COVID-19 after experiencing fever for 2 weeks, urinary retention, fecal retention, and pain in both lower extremities for a week. Diagnoses: The patient diagnosis was established using thoracic and lumbar magnetic resonance imaging (MRI). Contrast-enhanced thoracic and lumbar MRI revealed subdural (dorsal predominant) short T1 and slightly long T2 bands in the T12-S2 infundibular canal in the scan field, and the subdural hematoma was yet to be distinguished from other diseases. Spinal cord edema was observed in the left vertebral plate and facet joint of the T11 vertebral body, indicative of inflammation. The cerebrospinal fluid (CSF) was positive for COVID-19 nucleic acid. Interventions: Antiinfection, immunomodulation, correction of acid-base balance and electrolyte disorders, improvement of circulation, nerve nutrition, and other symptomatic supportive treatments were administered to the patient. Outcomes: The patient symptoms significantly improved after 4 weeks of anti-infection and immunomodulatory therapy. Repeat thoracolumbar MRI revealed absorption of the spinal cord hematoma, and the patient was discharged from the hospital. To date, COVID-19-related hematomyelia has not been reported and anti-infective and immunomodulatory therapies may be effective. Lessons: COVID-19 not only easily leads to brain injury but can also cause spinal cord injury and even spinal cord hemorrhage. When patients with COVID-19 experience symptoms and signs of spinal cord injury, spinal cord injury and bleeding caused by COVID-19 should be considered, and MRI and lumbar puncture should be performed as soon as possible to make a clear diagnosis. Keywords: case report, coronavirus disease 2019, hematomyelia, pulmonary infection, spinal cord injury

CITATION EXPORT

Lin-Ming Zhang, Huan-Bo Zhang, Fu-Rong Fan et al.. Hematomyelia associated with coronavirus disease 2019: A rare case report. Medicine. (2023). https://doi.org/10.1097/MD.0000000000034197

AUTHORS

4 · 3 CENTRES

Lin-Ming Zhang, Huan-Bo Zhang, Fu-Rong Fan, Ming-Wei Liu

a Department of Neurology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
b Trauma Center, the First Affiliated Hospital of Kunming Medical University, Kunming, China
c Department of Emergency Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming, China.