SARS-CoV-2 has been shown to cause numerous neurologic sequelae, including meningoencephalitis, ischemic or hemorrhagic stroke, and acute disseminated encephalomyelitis. Following respiratory symptoms, acute transverse myelitis has also been reported. Neuromyelitis Optica (NMO) is a rare, inflammatory demyelinating disease of the central nervous system (CNS), predominantly affecting the optic nerves and spinal cord. We report a case of NMO occurring in a patient who initially presented with acute meningoencephalitis of unknown etiology and, shortly thereafter, was found to be SARS-CoV-2 antibody positive.
NMO is a rare demyelinating disorder of the CNS. Some studies of NMO have suggested a triggering role for infectious agents, but the primary immunizing event remains poorly understood. Here we describe a case of NMO presenting in a SARS-CoV-2 antibody positive patient after an initial hospitalization for meningoencephalitis of unknown etiology.
The case report was compiled using outside hospital and Thomas Jefferson University Hospital electronic medical record data. Figures were obtained through PACS and formatted in Microsoft Powerpoint.
NMO is diagnosed by the presence of at least 1 of 6 core clinical characteristics and detection of AQP4-IgG. The core clinical characteristics implicate 6 CNS regions including optic nerve, spinal cord, area postrema of the dorsal medulla, brainstem, diencephalon, or cerebrum. Our patient had 2 core clinical characteristics including spinal cord lesion spanning greater than 3 segments and area postrema syndrome due to dorsal medullary lesion. Furthermore, his serum AQP4-IgG was positive. He developed these symptoms after becoming seropositive for SARS-CoV-2 antibodies with a positive nasopharyngeal swab test.
This is the first case report about NMO potentially triggered by SARS-CoV-2 infection. While causality remains difficult to prove, the temporal relationship between SARS-CoV-2 infection and NMO attack is compelling for parainfectious phenomenon.