Endocrine Abstracts

Introduction: The SARS-CoV-2 virus has caused the recent pandemic. Most affected patients have gone through a rather mild disease. However, some of the patients have gone through a severe illness requiring admission to an acute care unit. Some survived while others succumbed to the disease. In some patients the SARS-CoV-2 infection was characterized by neurological manifestations. One of these is transverse myelitis thought to be caused either by the virus itself as the SARS-CoV-2 virus may be neuroinvasive or by an autoimmune reaction due to molecular mimicry between the viral and host proteins.

Aim: The aim was to describe the case of a male patient with Hashimoto’s thyroiditis who developed transverse myelitis in the course of COVID-19 illness.

Case description: The case of a 52 year-old male patient is described. The patient presented with Hashitoxicosis approximately 15 years ago at the age of 37 years. TSH was 0.01 μIU/ml, anti-Tg and anti-TPO antibodies were positive, while a thyroid ultrasonogram revealed loss of homogeneity of the thyroid parenchyma. Unimazole was administered. During the course of the disease the patient developed hypothyroidism and thyroxine was administered. Approximately a year ago he presented with COVID-19 disease and a rather severe illness. The patient was admitted to a COVID-19 department. During hospitalization he started to feel numbness in the lower extremities and subsequently the lower extremities were paralyzed. Transverse myelitis was diagnosed and prednisolone was administered. Over the course of two months prednisolone was tapered and the patient improved. During the course of a year the patient improved substantially and is now in a program of rehabilitation. He is able to walk independently without the use of walking aids.

Conclusions: Transverse myelitis in the course of COVID-19 disease has been described. The disease may be due to the virus itself, as it may be neuroinvasive or to an autoimmune reaction due to molecular mimicry, i.e. due to the homology of amino acid sequences of the viral proteins to human amino acid sequences. Thus, an immune reaction to the SARS-CoV-2 virus leads to an immune reaction to proteins of the human host and the development of clinical autoimmune disease. The SARS-CoV-2 virus is neuroinvasive and may have led to the development of transverse myelitis. Alternatively, the SARS-CoV-2 virus may be a virus which leads to autoimmunity and may have led to an autoimmune reaction in a vulnerable host, as the patient described herein.