Acute longitudinal extensive transverse myelitis following the second dose of an inactivated COVID-19 vaccine: A case report of the youngest patient with post-Sinovac™ tetraplegia and poor prognosis

During the novel coronavirus disease 2019 (COVID-19) pandemic, dozens of cases of acute transverse myelitis have been reported, either related to the disease itself or to various types of vaccines. However, rare cases of longitudinal extensive transverse myelitis (LETM) with relatively good prognosis have been reported, particularly after other COVID-19 vaccines, such as adenovirus vector vaccine (Oxford™, AstraZeneca), messenger ribonucleic acid (mRNA) vaccine (BioNTech™, Pfizer) and protein subunit vaccine (Corbevax™, Dynavax). This case report presents the third, worst prognosis and youngest case of LETM documented in the literature in association with an inactivated COVID-19 vaccine. A 39-year-old female patient developed sudden-onset severe cervical and thoracic predominantly paresthesia which rapidly progressed to tetraplegia, widespread sensory loss, bowel and bladder dysfunction two weeks after the second dose of Sinovac™ (Sinovac Biotech) vaccine. Spine magnetic resonance imaging showed LETM from C3 to T3 spinal cord segments. The outcome of this Sinovac™-induced LETM patient, who was inadequately treated with corticosteroids in the acute phase, showed a poor prognosis despite months of neurorehabilitation.