Case Report: Transverse myelitis following CAR-T cell therapy for post-transplant lymphoproliferative disorder

We report a case of severe, irreversible transverse myelitis following CD19-directed CAR-T cell therapy (axicabtagene ciloleucel) for refractory post-transplant lymphoproliferative disorder (PTLD) in a young female lung-transplant recipient. This case illustrates an emerging neurotoxic complication of CAR-T cell therapy and highlights convergent risk factors including demographics, tumor type and CAR construct. We discuss current evidence of CAR-T-associated myelopathy, its proposed inflammatory and immune-trafficking mechanisms, and the potential contribution of interleukins and chemokines such as IL-1, IL-6, IL-18, CCL-2 and CXCL10 signaling to spinal cord injury. We further address diagnostic challenges, and review current management strategies such as corticosteroids, IL-1 blockade, and IL-6 neutralization. This report underscores the need for heightened vigilance, early imaging, and systematic reporting to improve prevention and treatment of this rare but severe CAR-T-related neurotoxicity.