1102 - Longitudinally Extensive Transverse Myelitis from C4 to conus from multiple possible viral etiologies in an immunocompetent patient: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

TB

Taylor A. Bourgeois, MD

Resident
Mount Sinai
Jersey City, New Jersey, United States

Co-Author(s)

IH

Isabelle G. Hentschel, BA

Medical Student
Geisel School of Medicine at Dartmouth
Rye, New York, United States
ME

Miguel X. Escalon, MD, MPH

Professor
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Submitter(s)

TB

Taylor A. Bourgeois, MD

Mount Sinai
Jersey City, New Jersey, United States

Case Diagnosis: Longitudinally Extensive Transverse Myelitis

Case Description: We present a case of a 51-year-old male with no medical history with myalgias and fever that progressed to bilateral lower extremity flaccid paralysis and urinary incontinence. Initial MRI spine survey was significant for hyperintensities from C4 to conus medullaris, concerning for Longitudinally Extensive Transverse Myelitis (LETM). CSF studies showed WBC 6341 (PMN >82%), RBC 589, protein 292, glucose 19. PCR was positive for Echovirus 6 and 11 antibody, West Nile Virus IgG, and VZV IgM. Further workup for demyelinating diseases and autoimmune causes was negative. He was treated with empiric antibiotics, acyclovir, dexamethasone taper, IVIG, PLEX, and cytoxan with minimal improvement. The patient then underwent a spinal cord biopsy that showed an incidental finding of xanthomas but was otherwise unrevealing. Interval MRI spine survey showed improved hyperintensities from T2 to conus medullaris, however, now with cord narrowing from the spinal biopsy site at T12.

Discussions:
The most common viruses to cause acute flaccid paralysis (AFP) belong to the enterovirus genus, which includes echoviruses and poliovirus. Non-polio Enteroviruses (NPEVs) include Enterovirus B serotype 11 as a commonly reported cause of AFP, however, it is less commonly implicated in LETM. More rare but still known causes of LETM include West Nile Virus (a flavivirus) and VZV noted in several case reports.

Conclusions:
It is unusual for an immunocompetent patient to have CSF positive for multiple viruses. It becomes difficult to distinguish the known culprit, though it is more likely for LETM to arise from a post-viral reaction. The unrevealing spinal cord biopsy represents the challenges of balancing diagnostic discovery with preserving functional recovery.