Transverse Myelitis in a Healthy Adult Female Patient: A Rare Viral Etiology.

Transverse myelitis (TM) is an uncommon but extensively documented neurological disorder marked by acute spinal cord inflammation, resulting in a spectrum of impairments including motor, sensory, and autonomic disturbances. We outline a rare case of viral-induced TM linked to COVID-19 and Coxsackie B viral infections. A 25-year-old healthy female patient presented with acute bilateral upper and lower extremity weakness, paresthesia, and urinary retention. MRI of the cervical spine revealed abnormal marrow signal intensity. Laboratory investigation highlighted the presence of SARS-CoV-2 RNA; Coxsackie B virus subtypes 1, 2, 4, 5, and 6; and positive Lyme disease IgG subtype. Lumbar puncture and systemic autoimmune cases of myelopathy were unrevealing. Treatment included high-dose steroids, plasmapheresis, Foley catheter placement, and continual physical therapy. Despite improvements, the patient did not reach baseline and was discharged for outpatient physical/occupational rehabilitation. To our knowledge, this is the only case that describes viral-induced TM associated with COVID-19, Coxsackie B, and Lyme disease simultaneously. The rarity of this case highlights the necessity for further investigation into the pathogenesis of viral-induced TM and whether viral causes contribute synergistically or independently to the onset of TM.