Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report

Table 1 Laboratory indices of rheumatologic disorders

Specific test	Individual result (normal range)	Test results in context of undifferentiated connective tissue disease[16]
Anti-Smith antibody	< 0.2 AI (≤ 0.9)	Highly sensitive for SLE
Anti-DS DNA	< 12 IU/mL (< 30)	Specific to SLE
SSA Ab (anti-Ro AB)	< 0.2 AI (≤ 0.9)	Seen as elevated in 90% of those with Sjogren’s and in 40%-50% of those with SLE
SSB AB (anti-La Ab) anti	< 0.2 AI (≤ 0.9)
Scleroderma Ab IgG	< 0.2 AI (≤ 0.9)	Specific to scleroderma but can be found as positive in combined rheumatologic disorders
Jo-Ab	< 0.2 AI (≤ 0.9)	Positive in dermatomyositis and polymyositis and in other CTD
Ribosomal RNP	< 0.2 AI (≤ 0.9)	Nonspecific index seen in SLE and other rheumatologic disorders
Scleroderma AB IgG	< 0.2 AI (≤ 0.9)	Specific to scleroderma

Artificial intelligence risk calculations were used to indicate likelihood of positivity. Tests were done using multiplex flow immunoassay. More specific units were not given by the reference lab but individual result findings represent a value under 20% of the upper limit of normal. The above laboratory tests were performed 2 d prior to transfer to rehabilitation in December 2020 during her acute episode of COVID-19. Most indices were performed with each subsequent flare of her condition and were not found outside the normal range except as noted in the text. AI: Artificial intelligence; anti-DS: Anti-double stranded; CTD: Connective tissue disease; RNP: Ribonucleoprotein; SSA and SSB: Sjogren syndrome antigens A and B; SLE: Systemic lupus erythematosus.

Table 2 Investigative studies of alternative diagnoses

Lab	Result
SARS-CoV-2	Positive
CSF enterovirus	Negative
CSF VZV	Not detected
CSF WNV	Not detected
CSF HSV	Not detected
AQP4	Not detected
Myelin basic protein	Elevated
MOG ab, IgG	Negative
Oligoclonal bands	Not detected
IgG synthesis CSF and serum	WNL

These studies of infectious or inflammatory disorders were performed to eliminate other etiologies of her symptoms. As findings were either nonspecific or negative, this individual’s diagnosis remained as spinal cord infarct. CSF: Cerebrospinal fluid; WNL: Within normal limits; VZV: Varicella zoster virus; WNV: West Nile virus; HSV: Herpes simplex virus; AQP4: Aquaporin-4; MOG: Myeline oligodendrocyte glycoprotein; ab: Antibody; IgG: Immunoglobulin G.

Table 3 Common symptoms of post-acute sequelae of COVID-19

Symptoms	Sneller et al[12]	Davis et al[13]	Present in case described
Fatigue	26%	98.3%	Yes
Cough	5%	66.2%	Yes
Concentration Deficit	12%	85.1%	Yes
Dyspnea	19%	77.4%	Yes
Anosmia/parosmia	14%	35.9%	No
Headache	12%	77%	Yes
Insomnia	9%	60%	No
Chest pain/discomfort	8%	53.1%	No
Anxiety	6%	57.9%	Yes
Myalgia	6%	69.1%	Yes
Tinnitus	6%	26.2%	No
Palpitations	5%	67.4%	No
Arthralgia	3%	52.2%	Yes
Taste disorder	5%	33.7%	Yes
Depression	3%	47.3%	Yes
Alopecia	4%	N/A	No
Dizziness	4%	67.3%	No
Paresthesias	1%	35.4%	Yes
Visual Impairment	1%	10.4%	No

Symptoms of two large coronavirus disease studies compared with the same symptoms in our case presentation, occurring at any point beyond 90 d of diagnosis.