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Gene & Protein in Disease MIS-A with LETM after SARS-CoV-2 vaccine

Table 2. Results of the follow‑up investigations
January 13, January 21, January 31, February 4, February 8, 2022
2022 2022 2022 2022
Hemoglobin (mmol/L) 1.1 1.66 1.64 1.30 1.33
Total leukocyte count (/L) 10.16×10 9 11.0×10 9 16.6×10 9 16.9×10 9 8.54×10 9
Differential leukocyte count P73L20% P76L21% P94L21% P90L8% P80L16%
Platelets (/L) 422×10 9 323×10 9 220×10 9 168×10 9 248×10 9
Blood urea nitrogen (mmol/L) 76.0 38.9 / 36.05 28.9
Creatinine (μmol/L) 619.7 381.9 / 263.4 127.3
Total bilirubin (μmol/L) 14.9 13.0 9.40 10.9 9.91
SGOT/SGPT (μKat/L) 1.26/0.78 0.81/0.63 0.34/0.36 0.53/0.73 0.35/0.46
Sodium/potassium (mmol/L) 133/5.5 138/5.2 128/5.5 133/3.9 131/4.3
PT/APTT/INR (s) 19.2/180/1.5 / 13.3/-/0.98 16.1/<min/1.2 /
D dimer/Fib / / / 12.90 mg/L /
Peripheral blood smear / / No toxic granules / /
2D echocardiography / / / / • Normal left ventricular function
• No regional wall motion abnormality
• LVEF: 60%
Note: /: Not done. Abbreviations: APTT: Partial thromboplastin time–activated; INR: International normalized ratio; LVEF: Left ventricular ejection fraction;
PT: Prothrombin time; SGOT: Serum glutamic‑oxaloacetic transaminase; SGPT: Serum glutamic‑pyruvic transaminase.

a case of LETM as a neurological manifestation of MIS-A
after SARS-CoV-2 vaccination. The case satisfied the
diagnostic criterion of MIS-A and also had LETM as
a neurological manifestation. This patient was initially
diagnosed as having sepsis with septic shock and multi-
organ dysfunction. However, the diagnosis of sepsis was
instantly ruled out given the constellation of symptoms and
rapid response to immunotherapy. For differential diagnosis
purposes, we also examined other causes of LETM, such as
vasculitis, neuromyelitis optica, and myelin oligodendrocyte
glycoprotein-related demyelination, which were however
found to be negative in this patient. After ruling out all types
of infections, including SARS-CoV-2, as the contributory
Figure 1. Longitudinally extensive transverse myelitis from the C6
segment to conus medullaris in the cervico-dorsal cord. factors of LETM, we considered vaccination a plausible
cause given the elevated SARS-CoV-2 antibody levels. As
Overall, the patient started recovering after IVIG was applied. the patient caught the SARS-CoV-2 infection approximately
Inotropes were tapered off on January 5, 2022, and she was 7 months before consulting us in the hospital, we believe it is
extubated on the same day. The patient regained MRC 5/5 more convincing to attribute SARS-CoV-2 vaccination to the
power in both upper limbs and MRC 2/5 power in both development of LETM and MIS-A, taking into account the
lower limbs and was able to sit with support after 1 month. recent vaccination 8 weeks before her visit to our hospital.
In addition, her bowel function and bladder sensation However, despite this speculation, a recent yet undiagnosed
improved after 1 month. Table 2 presents the results of the SARS-CoV-2 infection cannot be ruled out completely.
follow-up investigations. Informed consent was taken from
the patient before submitting this case report. 4. Conclusion
At present, there are no other cases reported in literature
3. Discussion corroborating LETM as a neurological manifestation
To the best of our knowledge, LETM has never been of MIS-A after SARS-CoV-2 infection or vaccination;
reported as a neurological manifestation of MIS-A after therefore, it is challenging to reach a definitive conclusion
SARS-CoV-2 infection or vaccination. Here we present on this topic. As the SARS-CoV-2 pandemic waxes and

Volume 2 Issue 3 (2023) 4 https://doi.org/10.36922/gpd.1320