SARS-CoV-2 infection complicated by acute longitudinally extensive transverse myelitis and pulmonary embolism: a case report

Coronavirus disease 2019 (COVID-19) presents with a wide spectrum of clinical manifestations. While primarily affecting the respiratory system, neurological involvement and thromboembolic complications have also been documented. This report describes a rare case of a 25-year-old male who developed acute longitudinally extensive transverse myelitis (LETM) complicated by pulmonary embolism (PE) and deep vein thrombosis (DVT) of the lower extremities following SARS-CoV-2 infection. The patient presented with acute chest tightness and pain, followed by high fever, which rapidly progressed to quadriplegia and sensory deficits. Magnetic resonance imaging (MRI) revealed abnormal signal intensity in the spinal cord from the C4 to T1 levels. Computed tomography pulmonary angiography (CTPA) confirmed PE, and laboratory tests were positive for SARS-CoV-2 nucleic acid. Although aquaporin-4 (AQP4), myelin oligodendrocyte glycoprotein (MOG), and glial fibrillary acidic protein (GFAP) antibodies were negative, cerebrospinal fluid analysis indicated inflammatory changes. Partial clinical improvement was achieved following treatment with high-dose corticosteroid pulse therapy, anticoagulation, and antiviral agents. This case highlights the potential of COVID-19 to simultaneously trigger neurological and vascular complications, underscoring the complexity of multi-system involvement by the virus. The underlying pathophysiological mechanisms involving potential “virus-immune-thrombosis” interactions are discussed in depth, providing important insights for clinicians to recognize and manage such complex cases.