|
|
Acute Transverse Myelitis in Pregnancy
|
Abstract:
Purpose: This case report highlights a rare instance of a 26-week pregnant woman presenting with limb numbness, diagnosed with acute transverse myelitis (ATM) following COVID-19 vaccination. Notably, she tested positive for neuromyelitis optica (NMO) but did not exhibit the typical symptoms of blurred vision. Methods: Data were collected from I Seha in governmental hospitals in Bahrain, providing a comprehensive overview of the patient’s clinical journey. Results: The patient was treated with carbamazepine, steroids, and clexane, leading to the successful delivery of a healthy baby at 34 weeks. However, two years postpartum, she reported new episodes of blurred vision and numbness. Subsequent treatment with Rituximab resulted in significant improvement, with a diagnosis of Devic’s disease established. Conclusion: Acute transverse myelitis is a rare condition, particularly during pregnancy, and in this case, symptoms of Devic’s disease were masked by the absence of blurred vision. This condition predominantly affects females in their 20s during childbearing years and can lead to complications such as premature delivery. Effective management includes steroids and antiepileptic drugs, with clexane playing a crucial role in preventing embolisms. A delivery mode may vary based on obstetric factors, and MRI remains the gold standard for diagnosis. Close follow-up is essential for optimal patient outcomes.
| [1] | Miranda-Acuña, J., Rivas-Rodríguez, E., Levy, M., Ansari, M., Stone, R., Patel, V., et al. (2019) Rituximab during Pregnancy in Neuromyelitis Optica: A Case Report. Neurology Neuroimmunology & Neuroinflammation, 6, e542. https://doi.org/10.1212/nxi.0000000000000542 |
| [2] | Borisow, N., Hellwig, K. and Paul, F. (2018) Neuromyelitis Optica Spectrum Disorders and Pregnancy: Relapse-Preventive Measures and Personalized Treatment Strategies. EPMA Journal, 9, 249-256. https://doi.org/10.1007/s13167-018-0143-9 |
| [3] | Carnero Contentti, E. and Correale, J. (2021) Neuromyelitis Optica Spectrum Disorders: From Pathophysiology to Therapeutic Strategies. Journal of Neuroinflammation, 18, Article No. 208. https://doi.org/10.1186/s12974-021-02249-1 |
| [4] | Siriratnam, P., Huda, S., Butzkueven, H., van der Walt, A., Jokubaitis, V. and Monif, M. (2024) Risks and Outcomes of Pregnancy in Neuromyelitis Optica Spectrum Disorder: A Comprehensive Review. Autoimmunity Reviews, 23, Article 103499. https://doi.org/10.1016/j.autrev.2023.103499 |
| [5] | Davoudi, V., Keyhanian, K., Bove, R.M. and Chitnis, T. (2016) Immunology of Neuromyelitis Optica during Pregnancy. Neurology Neuroimmunology & Neuroinflammation, 3, e288. https://doi.org/10.1212/nxi.0000000000000288 |
| [6] | Mao-Draayer, Y., Thiel, S., Mills, E.A., Chitnis, T., Fabian, M., Katz Sand, I., et al. (2020) Neuromyelitis Optica Spectrum Disorders and Pregnancy: Therapeutic Considerations. Nature Reviews Neurology, 16, 154-170. https://doi.org/10.1038/s41582-020-0313-y |
| [7] | Shosha, E., Pittock, S.J., Flanagan, E. and Weinshenker, B.G. (2017) Neuromyelitis Optica Spectrum Disorders and Pregnancy: Interactions and Management. Multiple Sclerosis Journal, 23, 1808-1817. https://doi.org/10.1177/1352458517740215 |
| [8] | Transverse Myelitis Consortium Working Group (2002) Proposed Diagnostic Criteria and Nosology of Acute Transverse Myelitis. Neurology, 59, 499-505. https://doi.org/10.1212/wnl.59.4.499 |
| [9] | Beh, S.C., Greenberg, B.M., Frohman, T. and Frohman, E.M. (2013) Transverse Myelitis. Neurologic Clinics, 31, 79-138. https://doi.org/10.1016/j.ncl.2012.09.008 |
| [10] | Mumenthaler, M. and Mattle, H. (2011) Neurology. Thieme. https://books.google.com.bh/books/about/Neurology.html?id=HfxvzwEACAAJ&redir_esc=y |
| [11] | Awad, A. and Stuve, O. (2011) Idiopathic Transverse Myelitis and Neuromyelitis Optica: Clinical Profiles, Pathophysiology and Therapeutic Choices. Current Neuropharmacology, 9, 417-428. https://doi.org/10.2174/157015911796557948 |
| [12] | Nardone, R., Versace, V., Brigo, F., Tezzon, F., Zuccoli, G., Pikija, S., et al. (2017) Herpes Simplex Virus Type 2 Myelitis: Case Report and Review of the Literature. Frontiers in Neurology, 8, Article No. 199. https://doi.org/10.3389/fneur.2017.00199 |
| [13] | Aslan, A., Kurugol, Z. and Gokben, S. (2014) Acute Transverse Myelitis Complicating Breakthrough Varicella Infection. Pediatric Infectious Disease Journal, 33, 1196-1198. https://doi.org/10.1097/inf.0000000000000418 |
| [14] | Caldas, C., Bernicker, E., Nogare, A.D. and Luby, J.P. (1994) Case Report: Transverse Myelitis Associated with Epstein-Barr Virus Infection. The American Journal of the Medical Sciences, 307, 45-48. https://doi.org/10.1097/00000441-199401000-00009 |
| [15] | Guerby, P., Vidal, F., Bayoumeu, F. and Parant, O. (2016) Paraplégie et grossesse: À propos d’une série rétrospective continue sur 11 années au CHU de Toulouse. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 45, 270-277. https://doi.org/10.1016/j.jgyn.2015.01.002 |
| [16] | Khan, E., Shrestha, A.K., Colantonio, M.A., Liberio, R.N. and Sriwastava, S. (2021) Acute Transverse Myelitis Following Sars-Cov-2 Vaccination: A Case Report and Review of Literature. Journal of Neurology, 269, 1121-1132. https://doi.org/10.1007/s00415-021-10785-2 |
| [17] | Chow, C.C.N., Magnussen, J., Ip, J. and Su, Y. (2020) Acute Transverse Myelitis in COVID-19 Infection. BMJ Case Reports, 13, e236720. https://doi.org/10.1136/bcr-2020-236720 |
| [18] | Kaur, H., Mason, J.A., Bajracharya, M., McGee, J., Gunderson, M.D., Hart, B.L., et al. (2020) Transverse Myelitis in a Child with Covid-19. Pediatric Neurology, 112, 5-6. https://doi.org/10.1016/j.pediatrneurol.2020.07.017 |
| [19] | Baghbanian, S.M. and Namazi, F. (2020) Post COVID-19 Longitudinally Extensive Transverse Myelitis (LETM)—A Case Report. Acta Neurologica Belgica, 121, 1875-1876. https://doi.org/10.1007/s13760-020-01497-x |
| [20] | Ahmad, S.A., Salih, K.H., Ahmed, S.F., Kakamad, F.H., Salh, A.M., Hassan, M.N., et al. (2021) Post COVID-19 Transverse Myelitis; A Case Report with Review of Literature. Annals of Medicine & Surgery, 69, 1-21. https://doi.org/10.1016/j.amsu.2021.102749 |
| [21] | Ostovan, V.R., Sahraian, M.A., Karazhian, N., Rostamihosseinkhani, M., Salimi, M. and Marbooti, H. (2022) Clinical Characteristics, Radiological Features and Prognostic Factors of Transverse Myelitis Following COVID-19 Vaccination: A Systematic Review. Multiple Sclerosis and Related Disorders, 66, Article 104032. https://doi.org/10.1016/j.msard.2022.104032 |
| [22] | West, T.W. (2013) Transverse Myelitis—A Review of the Presentation, Diagnosis, and Initial Management. Discovery Medicine, 16, 167-177. |
| [23] | West, T., Hess, C. and Cree, B. (2012) Acute Transverse Myelitis: Demyelinating, Inflammatory, and Infectious Myelopathies. Seminars in Neurology, 32, 97-113. https://doi.org/10.1055/s-0032-1322586 |
| [24] | Boubacar, S. and Toure, K. (2016) Myelopathy in Pregnant Women: A Case of Acute Transverse Myelitis at Fann Department of Neurology in Dakar (Senegal). Journal of Spine, 5, 2. |
| [25] | Misra, U.K. (2011) Diagnosis & Management of Neurological Disorders. Wolters Kluwer India Pvt Ltd. |
| [26] | (2021) Transverse Myelitis Fact Sheet, Transverse Myelitis Fact Sheet. https://files.wearesrna.org/sheets/TM.pdf |
| [27] | Lim, P.A.C. (2020) Transverse Myelitis. In: Frontera, W.R., Silver, J.K. and Rizzo, T.D., Eds., Essentials of Physical Medicine and Rehabilitation, Elsevier, 952-959. https://doi.org/10.1016/b978-0-323-54947-9.00162-0 |
| [28] | Cömert, P., Albayrak, M., Yıldız, A., Şahin, O., Öztürk, Ç.P., Maral, S., et al. (2019) An Acute Transverse Myelitis Attack after Autologous Stem Cell Transplantation: A Rare Case. Transfusion and Apheresis Science, 58, 341-343. https://doi.org/10.1016/j.transci.2019.05.002 |
| [29] | Borchers, A.T. and Gershwin, M.E. (2012) Transverse Myelitis. Autoimmunity Reviews, 11, 231-248. https://doi.org/10.1016/j.autrev.2011.05.018 |
| [30] | Wuebbolt, D., Nguyen, V., D’Souza, R. and Wyne, A. (2018) Devic Syndrome and Pregnancy: A Case Series. Obstetric Medicine, 11, 171-177. https://doi.org/10.1177/1753495x18758868 |
