Cho SY, Jang BH, Seo JW, Kim SW, Lim KJ, Lee HY, Kim DJ. Transverse myelitis caused by herpes zoster following COVID-19 vaccination: A case report. World J Clin Cases 2023; 11(6): 1419-1425 [PMID: 36926132 DOI: 10.12998/wjcc.v11.i6.1419]
Corresponding Author of This Article
Dong-Joon Kim, MD, PhD, Associate Professor, Department of Anesthesiology and Pain Medicine, Chosun University, College of Medicine, Pilmun-daero 365, Gwangju 61453, South Korea. djkim@chosun.ac.kr
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 26, 2023; 11(6): 1419-1425 Published online Feb 26, 2023. doi: 10.12998/wjcc.v11.i6.1419
Transverse myelitis caused by herpes zoster following COVID-19 vaccination: A case report
Su-Yeon Cho, Bo-Hyun Jang, Jun-Won Seo, Suk-Whee Kim, Kyung-Joon Lim, Hyun-Young Lee, Dong-Joon Kim
Su-Yeon Cho, Bo-Hyun Jang, Suk-Whee Kim, Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea
Jun-Won Seo, Department of Internal Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea
Kyung-Joon Lim, Hyun-Young Lee, Dong-Joon Kim, Department of Anesthesiology and Pain Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea
Author contributions: Lee HY conceived the article; Kim SW and Kim DJ collected the data; Seo JW and Lee HY assembled the data; Cho SY, Seo JW, Kim SW, Lim KJ, Lee HY, Kim DJ provided the study materials, write the manuscript and approved the manuscript.
Supported byResearch fund from Chosun University Hospital, 2022.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Joon Kim, MD, PhD, Associate Professor, Department of Anesthesiology and Pain Medicine, Chosun University, College of Medicine, Pilmun-daero 365, Gwangju 61453, South Korea. djkim@chosun.ac.kr
Received: November 30, 2022 Peer-review started: November 30, 2022 First decision: January 17, 2023 Revised: January 17, 2023 Accepted: February 3, 2023 Article in press: February 3, 2023 Published online: February 26, 2023 Processing time: 86 Days and 2.9 Hours
Abstract
BACKGROUND
Transverse myelitis (TM) is characterized by sudden lower extremity progressive weakness and sensory impairment, and most patients have a history of advanced viral infection symptoms. A variety of disorders can cause TM in association with viral or nonviral infection, vascular, neoplasia, collagen vascular, and iatrogenic, such as vaccination. Vaccination has become common through the global implementation against coronavirus disease 2019 (COVID-19) and reported complications like herpes zoster (HZ) activation has increased.
CASE SUMMARY
This is a 68-year-old woman who developed multiple pustules and scabs at the T6-T9 dermatome site 1 wk after vaccination with the COVID-19 vaccine (Oxford/ AstraZeneca ([ChAdOx1S{recombinant}]). The patient had a paraplegia aggravation 3 wk after HZ symptoms started. Spinal magnetic resonance imaging (MRI) showed transverse myelitis at the T6–T9 Level. Treatment was acyclovir with steroids combined with physical therapy. Her neurological function was slowly restored by Day 17.
CONCLUSION
HZ developed after COVID-19 vaccination, which may lead to more severe complications. Therefore, HZ treatment itself should not be delayed. If neurological complications worsen after appropriate management, an immediate diagnostic procedure, such as magnetic resonance imaging and laboratory tests, will start and should treat the neurological complications.
Core Tip: Reports are increasing that transverse myelitis (TM) is a rare herpes zoster (HZ) complication and is linked to coronavirus disease 2019 (COVID-19) vaccines. HZ following the COVID-19 vaccination may lead to more severe complications due to the vaccine immunocompromising the patient. Typically, complications like TM from HZ may be rare, and difficult to diagnose. If there is diagnosis confusion, TM will progress rapidly, delaying the appropriate treatment. A critical point is to implement appropriate HZ therapy without delay simultaneously with neurological examination to evaluate TM progress and treatment and HZ care with pain control to protect against complications like postherpetic neuralgia.
