Introduction

Acute transverse myelitis (ATM) is a rare neurological complication of Coronavirus disease (COVID-19) vaccines. Various vaccines have been linked to ATM, such as non-replicating viral vectors, ribonucleic acid, and inactivated vaccines. An ATM case is presented here involving the BNT162b2 vaccine leading to asymmetrical incomplete paraplegia and neurogenic bladder.

Case presentation

A 66-year-old male developed urinary retention one day after his second dose of the BNT162b2 vaccine, followed by rapidly progressing lower limb weakness. Clinical examination showed asymmetrical paraparesis, reduced sensation below the T8 level, including perianal sensation, and loss of ankle and anal reflexes. Laboratory tests were largely unremarkable, while the spine MRI revealed thickened conus medullaris with a mild increase in T2/STIR signal intensity and subtle enhancement post gadolinium. Following treatment with methylprednisolone, plasmapheresis, and immunoglobulin, and a rehabilitation program, the patient achieved good motor and sensory recovery, but the bladder dysfunction persisted. Single-channel cystometry indicated neurogenic detrusor underactivity and reduced bladder sensation, as evidenced by low-pressure and compliant bladder. The urethral sphincter appeared intact or overactive. The post-void residual urine was significant, necessitating prolonged intermittent catheterisation.

Discussion

Bladder dysfunction due to the COVID-19 vaccine-associated ATM is not as commonly reported as motor or sensory deficits. To our knowledge, this is the first case to highlight a neurogenic bladder that necessitates prolonged intermittent catheterisation as a consequence of COVID-19 vaccine-associated ATM. This report highlights the rare complication of the neurogenic bladder resulting from the BNT162b2 vaccine. Early detection and treatment are crucial to prevent long-term complications.

中文翻译：

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关于 COVID-19 疫苗相关急性横贯性脊髓炎神经源性膀胱的报告

介绍

急性横贯性脊髓炎 (ATM) 是冠状病毒病 (COVID-19) 疫苗的一种罕见神经系统并发症。各种疫苗已与 ATM 相关联，例如非复制病毒载体、核糖核酸和灭活疫苗。这里介绍的 ATM 病例涉及 BNT162b2 疫苗导致不对称不完全性截瘫和神经源性膀胱的情况。

案例展示

一名 66 岁男性在注射第二剂 BNT162b2 疫苗一天后出现尿潴留，随后下肢无力迅速进展。临床检查显示不对称性截瘫、T8 水平以下的感觉减弱（包括肛周感觉）以及踝关节和肛门反射丧失。实验室检查基本没有异常，而脊柱 MRI 显示髓圆锥增厚，T2/STIR 信号强度轻微增加，钆后有轻微增强。经过甲基泼尼松龙、血浆置换和免疫球蛋白治疗以及康复计划后，患者的运动和感觉恢复良好，但膀胱功能障碍仍然存在。单通道膀胱测压显示神经源性逼尿肌活动不足和膀胱感觉减弱，如低压和顺应性膀胱所证明的那样。尿道括约肌显得完整或过度活跃。排尿后残留尿量显着，需要长时间间歇导尿。

讨论

由于与 COVID-19 疫苗相关的 ATM 导致的膀胱功能障碍不像运动或感觉缺陷那样常见。据我们所知，这是首例强调神经源性膀胱因与 COVID-19 疫苗相关的 ATM 导致需要长时间间歇性导尿的病例。该报告强调了 BNT162b2 疫苗引起的神经源性膀胱的罕见并发症。早期发现和治疗对于预防长期并发症至关重要。